Lydia Ortega
Banning,CA
Summary
Dynamic Claim Examiner with expertise in claims management at Riverside San Bernardino County Indian Health. Proven ability to enhance data accuracy and streamline processes, reducing claim processing time. Strong communicator skilled in resolving complex billing discrepancies, ensuring efficient financial processing and continuity of care for patients.
Overview
5
5
years of professional experience
1
1
Certification
Work History
Claim Examiner
Riverside San Bernardino County Indian Health
11.2024 - Current
- Handled sensitive information with discretion, ensuring confidentiality of personal and financial details for claimants throughout the claims examination process.
- Utilized analytical skills to evaluate medical bills for accuracy and appropriateness of charges before approving payments as part of the claims process.
- Participated in cross-functional team meetings to address organizational challenges related to claims management and develop solutions collaboratively.
- Reduced claim processing time by implementing efficient workflow strategies and prioritizing tasks effectively.
Referral Management
Riverside San Bernardino County Indian Health
07.2020 - 11.2024
- Coordinated referral management tasks, resulting in improved access to specialized care for patients.
- Developed strong relationships with area specialists to facilitate effective referral management for patients requiring additional care services.
- Contributed to a positive work environment by actively participating in team meetings, offering constructive feedback, and sharing best practices for efficient referral management.
- Coordinated referral management processes between primary care providers and specialists or diagnostic services to ensure continuity of care for patients.
Education
High School Diploma -
Banning High
Banning, CASkills
- Claims management
- Effective verbal communication
- Data accuracy assessment
- Communicated with department directors to resolve complex billing discrepancies and ensure accurate invoicing for payment
- Managed check run procedures within Plexis, contributing to efficient claims payment and financial processing
- Performed eligibility checks in Nextgen, confirming that all documentation and criteria were fulfilled for converge and compliance
- Complied and processed CHEF claims for IHS reimbursements, securing financial returns for high-cost patient care cases
Certification
Medical Assistant
Esthetician
Timeline
Claim Examiner
Riverside San Bernardino County Indian Health
11.2024 - Current
Referral Management
Riverside San Bernardino County Indian Health
07.2020 - 11.2024
High School Diploma -
Banning High