Teri Ortiz
Windsor,CA
Summary
Seasoned professional from Petaluma Health Center, adept in insurance verification and claims management, showcases exceptional leadership and effective communication skills. Spearheaded process improvements, enhancing operational efficiency, and mentored new staff, ensuring high-quality customer service and compliance with HIPAA and other regulations.
Overview
35
35
years of professional experience
Work History
Referrals and Authorizations
Petaluma Health Center
Petaluma, California
02.2005 - 03.2024
- Remained calm and professional in stressful circumstances and effectively diffused tense situations.
- Resolved customer inquiries and complaints requiring management-level escalation.
- Delegated work to staff, setting priorities and goals.
- Provided leadership, insight and mentoring to newly hired employees to supply knowledge of various company programs.
- Recruited and trained new employees to meet job requirements.
- Reviewed completed work to verify consistency, quality, and conformance.
- Provided customer service to internal and external customers related to authorization requests.
- Reviewed authorization requests for accuracy and completeness.
- Researched patient eligibility, coverage information, and benefit levels.
- Maintained current knowledge of applicable regulations, laws, and standards.
- Verified insurance authorizations with payers via telephone or web-based systems.
- Processed prior authorization requests in accordance with departmental guidelines.
- Assisted in the development of new processes and protocols to improve operational efficiency.
- Tracked authorization statuses using electronic databases or manual filing systems.
- Coordinated communication between providers, patients, payers, and other departments as needed.
Office Manager
Rosalyn Lepley, MD
Santa Rosa, California
01.1989 - 03.2005
- Developed and implemented office policies and procedures.
- Assisted with the preparation of budgets, forecasts and financial statements.
- Supervised staff members, organized schedules and delegated tasks.
- Ordered supplies and equipment to maintain adequate inventory levels.
Education
High School Diploma -
Oceana
Pacifica, CA06-1979
Skills
- Claims Management
- Insurance Verification
- HIPAA Compliance
- Medical terminology expertise
- Medical coding knowledge
- Prior authorization processing
- Effective communication skills
- Documentation and paperwork
- Telephone Etiquette
- Verbal Communication
- Medicaid knowledge
- Eligibility procedures
- Disability Awareness
Timeline
Referrals and Authorizations
Petaluma Health Center
02.2005 - 03.2024
Office Manager
Rosalyn Lepley, MD
01.1989 - 03.2005
High School Diploma -
Oceana
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