VERNON TORTI
CANAL WINCHESTER,UNITED STATES OF AMERICA
Summary
Well-rounded professional with extensive experience spanning over three decades, demonstrating exceptional leadership and communication skills. Proven ability in customer retention and service, complemented by proficiency in audio mixing and computer applications such as Microsoft Word. Committed to fostering a supportive learning environment while driving process improvements and maintaining high standards in all instructional activities.
Skilled specialist with a proven track record in delivering impactful results. Adept at team collaboration and flexible in adapting to changing needs. Expertise in audio production, consistently driving successful outcomes. Known for reliability and a strong focus on achieving objectives. Experienced with advanced sound mixing, recording, and post-production techniques essential for audio engineering roles. Utilizes audio editing software and sound design tools to create high-quality auditory experiences. Strong understanding of studio equipment optimization and team collaboration, ensuring seamless and professional audio output.
Overview
32
32
years of professional experience
1
1
Certification
Work History
SPECIALIST, APPEALS & GRIEVANCES
Molina Healthcare
United States
05.2023 - Current
- Process grievances, approximately 25 to 50 cases per day for healthcare, ensuring compliance with regulatory standards while maintaining accurate documentation and timely resolution.
- Review medical documentation and policy guidelines to determine appropriate resolution paths, implementing quality control measures for case management.
- Maintain 95% to 100% weekly quality review audits for cases processed.
ASSOC. REP - PROVIDER INQUIRY
Molina Healthcare
Columbus, Ohio, United States
12.2020 - 05.2023
- Review provider submitted disputes and appeals. Builds cases based on submission and review documents to determine appropriate process. Forwards cases to clinical or non-clinical review based on submissions. Assist as requested by management.
- Managed provider dispute resolution process, evaluating complex medical documentation and routing cases to appropriate clinical or non-clinical review channels
- Streamlined case documentation workflow by implementing systematic review protocols for provider appeals and dispute submissions
APPEALS SPECIALIST
Integrated Resources on assignment with Molina Healthcare
Columbus, Ohio
11.2019 - 12.2020
- Reviewed provider disputes, ensuring precise documentation and process accuracy.
- Directed cases to suitable review, optimizing workflow efficiency.
- Analyzed appeals, enhancing resolution timelines with measurable results.
ACCOUNTS RESOLUTION SPECIALIST
MedAssist, a Firstsource company
Gahanna, Ohio
06.2016 - 11.2019
- Research outstanding Medicaid in state and out of state and/or commercial insurance balances for hospital group.
- Contact insurance plans for clarification of remittance advice notes for resolution of discrepancies to resolve accounts.
- Obtain clarification on denied lines on claims if necessary to determine changes needed for possible reversal of denials or appeals.
- Print and submit medical records from client’s electronic medical records system for submitting to payers when necessary.
- Submit requests for review with provider clients for changes in billed procedures or modifiers to attempt compliance with payers in gaining further payment of claims.
- Compile and submit appeal letters to payers to attempt denials being overturned.
- Follow-up with Medicaid and Commercial Insurance payers on appeals or resubmitted claims Document and/or update information in AS/400 system and excel spreadsheets, as well as client electronic medical record system.
- Discovered method to submit electronic medical records saving time and paper.
- Taught method to team.
- Given confidence of colleagues in supporting them as unofficial subject matter expert as well minor IT issues.
- Repeatedly selected by Director of office to take on new roles and be part of new project for a client.
SALES TEAM MEMBER
Target Mobile (Marketsource)
Columbus, Ohio Area
06.2015 - 12.2016
- Sales and customer education on cell phones and cell services.
- Support general electronics sales.
- Provide technical and sales assistance to target guests in relation to mobile phones, TVs, Laptop/tablets, home networking needs, audio electronics, printers and electronic gaming.
RESOLUTION TEAM LEADER
Express Scripts (formerly Medco Health)
Dublin, Ohio
01.2002 - 10.2014
- Senior level inbound customer service for a Fortune 500 Prescription Benefits Management company and mail service pharmacy
- Entrusted with escalated complex customer service issues due to ability to use communication skills in listening to the heart of customers concerns, to take on accountability of issues presented and to follow through to end resolution.
- Achieve resolution to customer issues through proper utilization of resources including communication with internal groups within company.
- Facilitate customer service function by acquiring excellent job knowledge to provide coaching and information support for customer service representatives.
- Consulted by higher management as a resource for recognizing trends on issues and call types.
- Contribute to updates and additions to database tools that provide procedural and informational support to customer service.
- Participate in special projects as assigned by management.
- Successful at maintaining high quality scores on calls.
- Adapt to new systems and procedures as introduced while maintaining success.
LOGISTICS RATE ANALYST
American International Forwarding, Inc
11.2000 - 10.2001
- Managed pricing and billing for international household moves, ensuring cost efficiency.
- Selected vendors to maintain quality and minimize expenses for each move segment.
- Estimated move costs with precise data to meet internal deadlines.
- Communicated daily with vendors to reconcile costs on completed moves.
- Collaborated in vendor selection and process improvement within the rate team.
PURCHASING AGENT
Raleigh Crabtree Marriott
01.2000 - 10.2000
- Responsible for food and beverage inventory for 365-room hotel and banquet facility.
- Managed daily purchasing and inventory maintenance for food and beverage outlets while working towards cost containment and cost reduction where needed.
- Reconciled daily purchase logs and coded invoices by using accounting skills and attention to detail.
- Accomplished inventory maintenance by using PC skills and specific inventory software.
- Supervised store room employees and participated in workshop to aid in this function.
ASSISTANT DIRECTOR OF PURCHASING
The Carolina Inn
07.1996 - 10.1999
- Assisted with food and beverage inventory for historic hotel and banquet facility near university campus.
- Entrusted with handling produce orders completely on own.
- Accomplished full understanding of job and gained management trust by handling department on own in Directors absence.
- Communicated in daily meetings with departments and management to review banquet functions.
- Coordinated receiving, shipping and expediting of guest packages.
- Utilized computer skills to simplify daily and monthly bookkeeping.
MOBILE DJ
Complete Music
Durham, NC
11.1996 - 05.1997
- Curated diverse music playlists tailored to audience preferences and event themes.
- Operated sound and lighting equipment, ensuring optimal performance during events.
- Engaged with clients to assess needs and customize event experiences.
MOBILE DJ
Other
Burlington, Massachusetts
03.1994 - 03.1997
- DJ for parties, weddings
Intern
WZLX -FM Major Market Radio Station
Boston, MA
07.1994 - 02.1995
- Assisted in the production of on-air content, ensuring timely delivery and adherence to station standards.
- Supported promotional events by coordinating logistics and engaging with listeners.
- Collaborated with team members to develop creative scripts for broadcasts and advertisements.
Education
Bachelor of Science - BS - Recording Arts - Audio Production
Full Sail University
Winter Park, FL06-2026
Web Design -
University of Michigan Through Coursera
01-2020
Diploma in Broadcasting - Radio and Television Broadcasting
Northeast Broadcasting School (now New England Institute of Art)
Brookline, MAB.A - English Literature
The Catholic University of America
Washington, DCSkills
- Pro Tools
- Communication
- Logic Pro
- Abelton
- Customer Service
- Purchasing
- Public Relations
- Problem Solving
- Piano Playing
- Drum Set
- Audio Mixing
- Video Editing
- Leadership
- Microsoft Office
- Time Management
Certification
Pro Tools certification expected in next 3 months
Dante certifications
Timeline
SPECIALIST, APPEALS & GRIEVANCES
Molina Healthcare
05.2023 - Current
ASSOC. REP - PROVIDER INQUIRY
Molina Healthcare
12.2020 - 05.2023
APPEALS SPECIALIST
Integrated Resources on assignment with Molina Healthcare
11.2019 - 12.2020
ACCOUNTS RESOLUTION SPECIALIST
MedAssist, a Firstsource company
06.2016 - 11.2019
SALES TEAM MEMBER
Target Mobile (Marketsource)
06.2015 - 12.2016
RESOLUTION TEAM LEADER
Express Scripts (formerly Medco Health)
01.2002 - 10.2014
LOGISTICS RATE ANALYST
American International Forwarding, Inc
11.2000 - 10.2001
PURCHASING AGENT
Raleigh Crabtree Marriott
01.2000 - 10.2000
MOBILE DJ
Complete Music
11.1996 - 05.1997
ASSISTANT DIRECTOR OF PURCHASING
The Carolina Inn
07.1996 - 10.1999
Intern
WZLX -FM Major Market Radio Station
07.1994 - 02.1995
MOBILE DJ
Other
03.1994 - 03.1997
Bachelor of Science - BS - Recording Arts - Audio Production
Full Sail University
Web Design -
University of Michigan Through Coursera
Diploma in Broadcasting - Radio and Television Broadcasting
Northeast Broadcasting School (now New England Institute of Art)
B.A - English Literature
The Catholic University of America