Shonta Ortiz

Identify and perform outreach, research, and resolve all open or pending authorization issues that impact claim denials, or reconsiderations, or appeals. Manage other self-assigned projects that arise through digital transformation and organizational method changes. I review authorization and system errors and resolve them promptly to ensure processing requirements are followed by guidelines. I provide reporting in Salesforce on authorization issues and trends identified related to claim denials, reconsiderations, and appeals. I review check runs for claims and system configuration accuracy. Performs other duties as assigned and collaborate and provide guidance to teammates on complex accounts. I comply with all the companies’ policies and standards, successful working within tight deadlines and a fast-paced environment.

• Reviewed and organized daily tasks, prioritized multiple projects and deadlines, as a leader, independently, and as a member of the team pulling daily spreadsheet reports and updating client folders. Processed and updated data for monthly enrollments and escalate issues for resolution. Monitor JIRA tickets and update condition/status codes daily. Communicated with team and management using Smartsheet to stay informed on daily progress and updates needed to keep up on changes or company metrics. Submit monthly Capstone Quick list for clients' records and update all trackers and submission logs.
• Managed data entry projects ensuring accuracy and consistency across all tasks.
• Trained new team members on data entry procedures and software tools.
• Streamlined documentation processes, reducing turnaround time for project completion.

• Handle 50-75 inbound calls daily and correspond through email for prior authorizations. Assist providers and nurses with requests for upcoming surgeries and procedures. Enter data into various systems and maintain regular attendance based on schedule.
• Managed intake processes, ensuring accurate data entry and client information verification.
• Coordinated communication between clients and service providers to streamline support services.
• Oversaw case documentation compliance, maintaining adherence to regulatory standards and best practices.
• Conducted regular assessments of client needs, facilitating tailored service plans to maximize satisfaction.
• Mentored junior intake representatives, fostering professional development and enhancing team performance.

• Handle 30-60 calls daily, assisting sales brokers with Medicaid eligibility checks. Verify insurance status through various platforms and assist with enrollment needs. Documented Salesforce with details on brokers' questions and provide follow-ups.
• Analyzed broker needs to develop tailored healthcare plans, enhancing member satisfaction and retention.
• Answered inquiries and provided information to various departments on a as needed basis, distributed appropriate paperwork, and fulfilled quote requests to deliver excellent broker support.
• Adhered to health and prescription insurance products, delivery systems, and claims systems.

• Support providers with processing pending applications for billing insurance companies. Screen applications for fraud and update providers and copy centers via email and chat. Answer heavy internal and external calls daily and monitor and update spreadsheets daily.
• Analyzed enrollment data to identify trends and improve service delivery efficiency.
• Participated in professional development opportunities, continuously refining skills and staying current on emerging trends within higher education administration spaces.
• Improved data accuracy, meticulously maintaining and updating applicant records.
• Monitored and reported on enrollment statistics, providing key stakeholders with insights into program performance.

• Maintain positive rapport with facilities and team members daily. Collect discharge data from facilities and update patient accounts in various systems. Notify departments regarding high dollar cases and Covid cases for tracking once discharged.
• Managed data entry processes to ensure accuracy and efficiency in information handling.
• Developed efficient data validation procedures, enhancing overall data integrity.
• Utilized advanced spreadsheet software to organize and analyze large datasets effectively.
• Collaborated with cross-functional teams to improve data-sharing protocols across departments.
• Maintained strict confidentiality of sensitive information, adhering to established guidelines and protocols.
• Completed data entry tasks with accuracy and efficiency.