Sorahida Ortiz
Orange,CA
Summary
Dynamic professional with extensive revenue cycle experience at R1 RCM. Proven track record in optimizing billing processes and fostering cross-departmental collaboration. Bilingual in English and Spanish, with expertise in conflict resolution and coding verification to ensure compliance and accuracy in financial transactions. Over 27 years of experience in billing and collections.
Overview
18
18
years of professional experience
Work History
Department Liaison
R1 RCM
01.2022 - Current
- Manage billing processes for government programs including Medicaid, Medi-Cal, and Medicare, ensuring compliance and accuracy across multiple facilities.
- Resolve billing issues through interdepartmental coordination while maintaining revenue integrity.
- Complete billing edits and denials, ensuring consistent revenue flow.
- Coordinate with billers and collectors to ensure accurate coding for clean claim submissions.
- Identify trends within claims to improve processing efficiency.
- Facilitate cross-departmental collaboration, enhancing workflow and communication across teams.
- Assist supervisor in reviewing reports and training new staff on departmental procedures.
Accounts Receivables Specialist
The Judge Group (Providence)
05.2021 - 12.2021
- Executed TAR, AUTH, and SAR submissions, securing timely approvals and minimizing delays.
- Submitted appeals to secure appropriate reimbursement for unresolved accounts.
- Managed billing and collections for multiple facilities during system transition.
- Ensured optimal workflow by using accurate adjustment and activity codes.
- Identified and escalated unresolved issues proactively to facilitate resolution.
- Assisted manager with reports and various assigned tasks.
CBO Plan Manager, Medi-Cal Unit
Prime HealthCare Corporate
Ontario, CA
02.2019 - 05.2021
- Submitted CIF appeals to Medi-Cal and managed care payers, ensuring accurate reimbursement.
- Reviewed and submitted TAR and SAR requests in compliance with state regulations.
- Managed billing and collections for 10 facilities serving California government payers.
- Collected on aged accounts, enhancing cash flow and decreasing outstanding balances.
- Identified trends impacting claims processing, ensuring adherence to HIPAA compliance.
- Trained staff on billing practices, ensuring adherence to quality control guidelines.
- Filed provider complaints with DMHC CSU, resolving service issues and improving provider relations.
- Assisted manager in preparing M7 reports for quarterly billing and collection meetings.
Medical Senior Collector
MemorialCare Shared Services
Fountain Valley, CA
09.2014 - 02.2019
- Managed billing and collections for inpatient, outpatient, psychiatric accounts, and government programs, ensuring compliance and accuracy.
- Addressed and resolved patient billing and collection issues independently, facilitating timely resolutions and enhancing patient satisfaction.
- Submitted TAR and SAR requests for necessary billing corrections after thorough reviews.
- Partnered with management to compile and present accurate billing and collection reports, supporting informed decision-making.
- Addressed credit resolution for inpatient/outpatient services and Medi-Medi claims.
Government Programs Specialist
KPC Healthcare
Santa Ana, CA
05.2008 - 09.2014
- Managed Medicare Part A and B billing for SNF and subacute accounts to ensure compliance and accuracy.
- Assisted with billing and collections for inpatient and outpatient accounts across government payers.
- Processed Medi-Medi claims for subacute and LTC services to ensure timely payment.
- Managed billing and collections for SNF subacute and long-term care accounts across all payers.
- Prepared and submitted CIF appeal forms to Medi-Cal, CRF PDR forms to Cal-Optima, and appeals to managed medical payers to secure proper reimbursements.
- Resolved credit accounts and processed refunds for inpatient, outpatient, and Medi-Medi accounts.
- Ensured proper reimbursement and accurate posting of payments for all SNF subacute/LTC accounts.
- Compiled and presented financial reports for hospital CFO and CBO director to inform decision-making.
Education
High School Diploma -
Southeastern High School
09-2010
Medical Assistant -
Santa Ana ROP
01-2001
Skills
- Billing compliance
- Revenue cycle management
- Claims management
- Coding verification
- Process optimization
- Epic software proficiency
- BillPro expertise
- Noridian knowledge
- Cross-departmental collaboration
- Staff training
- Attention to detail
- Interpersonal communication
- Conflict resolution
- Quick learner
- Bilingual English/Spanish
Timeline
Department Liaison
R1 RCM
01.2022 - Current
Accounts Receivables Specialist
The Judge Group (Providence)
05.2021 - 12.2021
CBO Plan Manager, Medi-Cal Unit
Prime HealthCare Corporate
02.2019 - 05.2021
Medical Senior Collector
MemorialCare Shared Services
09.2014 - 02.2019
Government Programs Specialist
KPC Healthcare
05.2008 - 09.2014
High School Diploma -
Southeastern High School
Medical Assistant -
Santa Ana ROP