JACKZENEE ORTEGA
San Francisco
Summary
Dynamic and resourceful professional recognized for fostering meaningful connections between clients and healthcare providers. Proven track record as an energetic Administrative Assistant, excelling in diverse roles while consistently delivering exceptional service. Compassionate and detail-oriented, equipped with strong organizational and decision-making skills that drive efficiency and effectiveness. Eager to leverage expertise in a challenging environment that promotes personal growth and contributes to overall company success.
Overview
6
6
years of professional experience
Work History
Member Services Representative
ALAMEDA ALLIANCE FOR HEALTH
10.2023 - 03.2024
- Serve as the primary contact for members, providers and authorized representatives for questions related to claims, benefits, member eligibility and other inquiries related to Alameda Alliance.
- Conduct telephonic member outreach regarding Medi-Cal benefits and services.
- Research complex issues across multiple databases and work with support resources to resolve escalated issues.
- Respond to and resolve member service inquiries and issues by identifying the topic and type of assistance the caller needs such as benefits, claims, eligibility, behavioral health and care coordination.
- Answer incoming calls, emails, and other requests for assistance in a timely manner in accordance with departmental performance targets and provide excellent customer service while doing so.
- Accurately document all calls/contacts as required by department standards via the Customer Relationship Management (CRM) system.
- Interface with Claims, Enrollment, IT, Network Management, Pharmacy, Authorizations and other internal departments to provide excellent service to members.
Behavioral Health Coordinator
PAIN AND REHABILITATIVE CONSULTANTS MEDICAL GROUP
02.2020 - 09.2023
- Document information for charts, physician reports, assessments and other paperwork within specific timeframes.
- Assess patient needs and provide high-quality care.
- Schedule patient follow-up appointments, psychological evaluations.
- Schedule interpretation and transportation services for patients.
- Follow up on pending treatment requests, authorizations, determination letters.
- Collaborate with multi-disciplinary staff to improve overall patient care and response times.
- Implement psychological assessments to patients via telehealth for documentation and reporting.
- Process treatment requests, extensions, authorizations, IMR's, denials, appeals, medical records.
- Answer and respond to high volume of calls and emails, mailing reminder letters and patient forms, faxing, collect co-pays, scan/upload documents.
Lead Medical Assistant
CONTRA COSTA INDUSTRIAL MEDICAL CLINIC
07.2018 - 12.2019
- Supervised, trained and coached team of medical assistants.
- Guided patients to room, recorded vital signs, discussed patient medical history and entered information for physician or other clinical staff to review.
- Set up, cleaned and stocked examination rooms with medical supplies.
- Prepared daily charts by creating and updating electronic health records system data prior to patient visits.
- Assisted patients with registration, new patient paperwork and check-out process.
- Performed preliminary physical tests to accurately record results in patient history summary.
- Relayed messages from patients to physicians about concerns, condition updates or refill requests to facilitate treatment.
- Prepared treatment rooms for patients by cleaning surfaces and restocking supplies.
- Efficiently performed insurance verification and pre-certification and pre-authorization functions.
- Assisted with diagnostic testing by collecting and packaging biological specimens for internal and laboratory analysis.
Education
High School Diploma -
Liberty High School
Brentwood, CA06.2013
Medical Assistant Certification -
Carrington College
Pleasant Hill, CA10.2019
Bachelor of Science - Health Administration
The University of Phoenix
Phoenix, AZ08-2025
Skills
- Health Administration
- Personnel Management
- Strategic Planning
- HIPAA/OSHA Compliant
- Office Administration
- CPT/ICD9-ICD10 Coding
- Microsoft Office: Word, Excel, Outlook, PowerPoint
- Utilization Management
- Care Coordination
- Employee Supervision/Training
- Verbal and Written Communication
- Customer Service-Oriented
- Data Entry and Outcomes
- Business Operations
- Time Management
Languages
Spanish
Native or Bilingual
Timeline
Member Services Representative
ALAMEDA ALLIANCE FOR HEALTH
10.2023 - 03.2024
Behavioral Health Coordinator
PAIN AND REHABILITATIVE CONSULTANTS MEDICAL GROUP
02.2020 - 09.2023
Lead Medical Assistant
CONTRA COSTA INDUSTRIAL MEDICAL CLINIC
07.2018 - 12.2019
High School Diploma -
Liberty High School
Medical Assistant Certification -
Carrington College
Bachelor of Science - Health Administration
The University of Phoenix
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