Playing Tennis, Traveling, and spending time with my family
Stephanie Ortiz
Fresno,CA
Summary
Specializing in Revenue Cycle Management, Coding, and Refund and Credit Balance resolution, with a strong focus on adjudication, coordination of benefits, and auditing. Over 15 years of comprehensive experience in the Revenue Cycle, demonstrating a proven ability to optimize processes and enhance financial performance. Committed to delivering exceptional results through strategic problem-solving and collaboration.
Overview
17
17
years of professional experience
Work History
Coder II
RI (Medirevv/Tegria)
Remote, CA
10.2022 - Current
- Analyzed and addressed coding discrepancies in prebilling claims to ensure accuracy and compliance with payer guidelines.
- Audit patient chart/medical records to accurately assign CPT-4, ICD-10CM, HCPS,modifiers based off CMS guidelines and organizational policies.
- Ensured adherence to quality and productivity standards exceeding 100%.
- Identify any insurance denial trends, Epic issues and/or new edits
- Proficient in multiple E/M specialties
- Analyze provider documentation to identify any discrepancies and provide feedback to Leadership
- Expedited project completion timelines with strong time management skills and adherence to deadlines.
- Monitored changes in coding regulations to provide recommendations for compliance.
Lead, Revenue Cycle
Medirevv (Providence)
Mission Hills, CA
03.2021 - 10.2022
- Managed reconciliation of financial data to ensure accuracy and compliance 3-5 million/monthly
- Review Cosmetic Dermatology, Ophthalmology, Orthopedic, Otolaryngology, ASC claims for proper billing and reimbursement.
- Identified and addressed account discrepancies, enhancing overall operational efficiency.
- Collaborated with cross-functional teams to streamline billing processes and improve workflows.
- Facilitated training sessions for new employees on policies and procedures related to Epic system.
- Establish process improvements to workflows to enhance efficiency and productivity
- Review Errors and PLB’s from Remittance Run
- Update Supervisor on team and individual work achievements, issues, and training needs
- Assign daily workflows and update both teams’ productivity
- Work higher dollar threshold invoices considered crucial based on business need.
- Audit payment posting to ensure proper posting, and Credit team for correct reimbursement to payors and patients.
- Analyzed account discrepancies to identify and resolve issues efficiently.
Senior Representative – Credit Balances
Medirevv (Providence)
Mission Hills, CA
02.2018 - 02.2021
- Work credit balances for all HMO, PPO, Third party carriers and Self-Pay accounts
- Approve patient/insurance refunds ($175 max)
- Identifying billing issues and trends and reporting them, EDI errors
- Responsible for resolving and/or appealing denials and rejections.
- Work aged account receivable and identify/correct billing errors.
- Extensive knowledge of insurances:PPO, EPO, HMO, Indemnity, Medicare, Medi-Cal, Worker’s Comp.
Research Analyst
Providence Health & Service
Mission Hills, CA
12.2013 - 02.2018
- Evaluated collection and customer service representatives to enhance training effectiveness.
- Streamlined internal workflows by automating data collection, analysis, and reporting tasks.
- Assist Management with admin correspondence, patient disputes.
- Process Third Party Liability request/documentation
- Special projects: TES edits, duplicate accounts, Escheat to State, MOOP
- Analyze discrepancies in copayment collection, SCHED, MCA Benefit category set up, & HMO adjudication in GE/IDX to resolve benefit issues
Collection Specialist
Providence Health & Service (Facey)
Mission Hills, CA
06.2013 - 12.2013
- Responsible for the collection of delinquent accounts according to the collection guidelines. Assign accounts to collection agency
- Approval/Denial of Financial Aid applications based on poverty/group guidelines.
- Review and resolve payment denials from carriers, research explanation of benefits for resubmission of claims in timely manner
- Contact Insurance carriers to review EOB’s, patient benefits, and claim processing.
Customer Service Representative
Facey Medical Foundation
Mission Hills, CA
12.2008 - 06.2013
- Handle a high volume of internal & external phone calls from patients, insurance carriers, and patient care sites
- Inform patients of financial responsibility options by share of cost, deductible, etc.
- Identify credits, adjustments and write offs provide necessary documentation for approval by management
- Responsible for setting up payment plans – collect patient credit card payments via phone, and applications for charity care
Medical Receptionist II
Facey Medical Foundation
Mission Hills, CA
12.2008 - 11.2012
- Schedule Routine OB/GYN, Behavioral Medicine, Internal Medicine appointments
- Pre-register patients, verify eligibility, billing/collecting procedures
- Ability to navigate health plan sites for verification of insurance eligibility & benefits
Education
Certified Professional Coder Apprentice -
AAPC
Mission Hills09.2020
CPC Coding Course -
AAPC
Mission Hills, CA10-2018
Medical Administrative Assistant Diploma Program - undefined
Everest Institute
Brighton, MA08-2007
High School Diploma - undefined
Sylmar High School
Sylmar, CA06-2004
Skills
- Excellent Customer service & communication skills, organized, can multi-task & work under pressure, detailed, goal oriented, highly motivated, and bilingual
- Knowledgeable in Medical Terminology and office procedures, HIPAA compliance, CMS Guidelines
- Proficient in MS Office, MS Excel, MS Word, Medisoft, MSI, Allscripts, IDX, GE Centricity, Epic, Practice Vision, Codonix
- Can perform ICD-10, CPT, HCPCS, Modifers
- Claims Auditing,Claims Adjudication,DOFR, Overpayment Resolution,Accounts Receivable
Interests
Timeline
Coder II
RI (Medirevv/Tegria)
10.2022 - Current
Lead, Revenue Cycle
Medirevv (Providence)
03.2021 - 10.2022
Senior Representative – Credit Balances
Medirevv (Providence)
02.2018 - 02.2021
Research Analyst
Providence Health & Service
12.2013 - 02.2018
Collection Specialist
Providence Health & Service (Facey)
06.2013 - 12.2013
Customer Service Representative
Facey Medical Foundation
12.2008 - 06.2013
Medical Receptionist II
Facey Medical Foundation
12.2008 - 11.2012
Medical Administrative Assistant Diploma Program - undefined
Everest Institute
High School Diploma - undefined
Sylmar High School
Certified Professional Coder Apprentice -
AAPC
CPC Coding Course -
AAPC