Aitsa Ortiz Email & Phone Number

Farmington, Ct

•Reviewing provider files for appropriate documentation required for the credentialing process.•Preparing files for audits and maintain electronic data input activities.•Coordinating credentialing and re-credentialing applications and conduct document research.•Collecting and maintaining files in relation to credentialing of network providers, including application, contracts, current physician licenses, DEA licenses, malpractice insurance, board certifications and other pertinent forms. •Performing credential verification and requesting information from appropriate data banks.•Submitting applications to manager, medical director and Credentialing Committee for review.

Wethersfield, Ct

• Compiled and maintained current and accurate data for all providers, such as education, training, experience, and licensure content. And entered information into Appogge Credentialing system. •Ensured practice addresses are current with health plans, agencies and other entities. •Completed provider credentialing and re-credentialing applications; monitors applications and follows-up as needed. •Tracked and maintained copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers•Identified issues that require additional investigation and evaluation, validated discrepancies and ensures appropriate follow up. Also prepared credentials file for completion.

Hartford, Connecticut Area

•Patient registration check in/out of appointments.•Patient insurance verification. Collected co-payments at the time of visit.•Helped answering incoming calls on the switchboard.

Enfield, Ct

•Worked with clients, referral sources, clinical staff, and the billing department in establishing and maintaining effective and appropriate treatment for clients dealing with addictions and mental health issues. Conducted random observed urine and hair toxicology screens on a daily basis, as well as assist in scheduling the appointments.•Provided clinical screening of referred clients for eligibility and treatment appropriateness, including entering relevant information into client’s electronic record and scheduling discharge meetings and satisfaction surveys with clients.•Worked with clinical staff by proving care coordination support, including making referrals to outside community services and assisting with intoxicated clients when needed.

Hartford, Connecticut Area

•Interfaced directly with a diverse population of patients, responding to various inquiries and concerns. •Experience in medical front desk in areas of manual and computerized scheduling, billing, and medical/insurance records management, including major carriers and Medicaid. •Obtained and processed patients' medical insurance information quickly and accurately. Processed an average of 500+ patients on a weekly basis for a fast-paced general practice. •Maintained open lines of communication between patients, physician, staff, and laboratory personnel. •Scheduled patients' medical screenings and following up to obtain results. •Respond to priority issues to ensure the prompt referral of urgently needed medical care. •Coordinate daily pharmaceutical-related matters to verify and expedite a high volume of prescription orders.

Berlin, Ct

•Provided exceptional office support to peers and senior management. Success streamlining office processes to increase efficiency. •Processed and distribute the weekly reports for the marketing, inside sales and distribute resources manager, and for the director of customer solutions.•Updated capital budget spreadsheet, where the entire new business requests for gas services, meter installations are tracked. Updated iAvenue database, where all the information is updated when meters and services are completed. Also enter the project numbers from the load sheet.•Contract processing and new business request. Received both information and scan to the company share drive to later add the information into the contract monitoring database. This also includes the creation of the contract folder. Send it all the original contracts to the legal department.•Performed wide-ranging office functions such as filing, copying, scanning. Handle all the distribution of all the correspondence. Mailed customers’ new contract for gas service. Send surge protectors requested by customers.

Hartford, Connecticut Area

•Assisted on the launch of Evercare Healthcare plans for the Hartford, New Haven and Windham Counties for senior citizens living in the community and assisted living communities. Processed enrollment applications for Dual eligible and Medicaid/Medicare members into company database.•Provided administrative /secretarial support for various departments including sales managers, account executives with duties such as answering telephones, assisting visitors, document preparation and assembling of presentations to potential healthcare providers resolving and; referring a range of administrative problems and inquires.•Assisted in the formatting & processing of physician contracts. Tracked and maintained weekly and monthly enrollment posting reports. •Extensive use of the HOST / NDB - Network Database program to gather healthcare provider information for proper referrals.•First point of contact when outside organizations and individuals needed literature or had any problems before being transferred to the provider relations departments.