Summary
Overview
Work History
Education
Skills
Timeline
Generic

SAMANTHA ORTEGA

Rancho Cucamonga,CA

Summary

Self-motivated and energetic Compliance Manager with a strong focus on team collaboration and achieving results, adaptable to changing needs. Skills include policy development, auditing, and stakeholder communication, with reputation for reliability and integrity.

Overview

16
16
years of professional experience

Work History

Patient Services Compliance Manager

Planned Parenthood
06.2019 - Current
  • Ensures that all clinical care is delivered in compliance with DHCS, CLIA, OSHA, BOP guidelines, etc.
  • Leads this process through setting up a system of audits and record keeping
  • Serves as resource to center staff regarding compliance, policies and SOPs
  • Maintains current clinic licenses and permits for operations
  • Reviewed documents, files, transcripts, and other records to assess compliance and potential risk.
  • Manage process of licensing and permitting for any new or expanding sites
  • Manage projects independently
  • Management of projects to include organization of deliverables, tracking of deliverables, and communication to affected parties through to completion
  • Collaborated with cross-functional teams to establish clear compliance guidelines and expectations for all departments.
  • Provided advice to senior management on potential risks, legal implications, and recommended solutions for complex compliance issues.
  • Prep health centers for any regulatory audits
  • Complete corrective action plans as needed
  • Maintains and responds to health plan member complaints and grievances
  • Conduct quarterly compliance audits and present data at quarterly meetings and committee
  • Maintains and reviews annual health plan provider manuals to ensure compliance with health plan expectations and DHCS standards
  • Manage and guide the Patient Service Compliance Assistant for success with their duties

Quality/Risk Management Coordinator

Greater El Monte Community Hospital
03.2015 - 06.2019
  • Review monthly PI submitted by directors
  • Conduct Physician Peer Review
  • Physician OPPEs
  • Minute taking for Quality meetings
  • Data abstractions
  • Data collection
  • Data entry
  • Reviewing patient charts for monthly reviews
  • Prepare cases for legal teams
  • Communicate closely with our legal teams
  • Risk Management reports
  • Daily rounds on units to correct any issues
  • Respond to patient or insurance grievances
  • Communicate with medical staff and medical directors regarding cases that need reviews
  • Assist with Root Cause Analysis
  • Attend corporate Quality meetings

Front Office Specialist

Planned Parenthood
11.2014 - 03.2015
  • Answer phones
  • Check in patients to their appointments
  • Verify patient insurance
  • Collect co-pays
  • Update patient accounts
  • Schedule appointments
  • Organize appointment calendar

Medical Receptionist

Planned Parenthood
07.2013 - 11.2014
  • Answer phones
  • Check in patients to their appointments
  • Verify patient insurance
  • Collect co-pays
  • Update patient accounts
  • Schedule appointments
  • Organize appointment calendar

Admitting Representative

San Gabriel Valley Medical Center
07.2009 - 08.2013
  • Answer phones
  • Check in patients to the Emergency Room or OP services
  • Verify patient insurance
  • Collect co-pays
  • Update patient accounts
  • Pre-Register accounts

Education

MASTERS - HEALTHCARE ADMINISTRATION

UNIVERSITY OF PHOENIX
03.2024

BACHELORS OF SCIENCE - HEALTHCARE MANAGEMENT

AZUSA PACIFIC UNIVERSITY
04.2020

Skills

  • Communication skills
  • Microsoft Office (Word, Excel, PowerPoint)
  • Outlook
  • Leadership
  • Time management
  • Organized
  • Reliable
  • Adaptable
  • Compliance monitoring
  • Training development
  • Internal auditing
  • Document reviews
  • Audit oversight and support
  • Compliance documentation
  • Staff training
  • Quality management processes
  • Risk assessment
  • SOP writing
  • Information gathering
  • Regulatory standards
  • Policy revision
  • Attention to detail
  • Problem-solving abilities
  • Team collaboration
  • Adaptability and flexibility

Timeline

Patient Services Compliance Manager

Planned Parenthood
06.2019 - Current

Quality/Risk Management Coordinator

Greater El Monte Community Hospital
03.2015 - 06.2019

Front Office Specialist

Planned Parenthood
11.2014 - 03.2015

Medical Receptionist

Planned Parenthood
07.2013 - 11.2014

Admitting Representative

San Gabriel Valley Medical Center
07.2009 - 08.2013

BACHELORS OF SCIENCE - HEALTHCARE MANAGEMENT

AZUSA PACIFIC UNIVERSITY

MASTERS - HEALTHCARE ADMINISTRATION

UNIVERSITY OF PHOENIX

Similar Profiles

CREATE PROFILE
SAMANTHA ORTEGA