Jacqueline A. Ortiz Email & Phone Number

North America

Outpatient and inpatient procedures.

Alhambra, California

• Review authorization queue for applicable orders
• Verify and comply with payer contractual authorization requirements
• Read orders for chemotherapy, radiology, Laboratory test
• Submit authorization request timely and efficiently, ensuring proper documentation is included for review
• Submitting authorization request via phone, providing clinical documentation such as pathology reports, radiology reports, progress notes, labs etc. to case manager or nurse reviewer.
• Utilize website portal, and electronic options to submit authorization request

North America

Los Angeles, Calfornia

• Follows up in the Emergency Room on admitted patients to ensure they are moved swiftly onto the floor
• Assigns hospital beds based on bed availability balancing with direct admits, hospital procedures and Emergency Room admissions.
• Monitors bed board of patients and notifies supervisor and nursing staff of changes in bed status at the start of the shift and throughout the day. Communicates with nursing staff during increasing or decreasing.
• Transfers patients in-house as needed, ensuring that critical transfers are given priority and while following hospital procedure.
• Informs the house supervisor or administration of any anticipated and/or actual issues/ problems.
• Handle inquiries and patient intake.

Beverly Hills, California

• Obtained supporting documentation from a clinically appropriate specialist or referring provider that supports care requested cannot be provided within the network.
• Researches information, depending on type of out-of-network specialty care requested, to find similar or like specialists who are contracted with the member’s plan.
• Coordinates scheduling with participating specialists to facilitate timeliness of care.
• Communicates effectively with all parties (members, providers, vendors, facilities and other staff members).
• Appropriate clinical information to participating specialist to assist within standards for timeliness of access to care.
• Documents in appropriate systems

Associate Of Science - As, Registered Nursing/Registered Nurse

Medical Billing Coding Certificate, Medical Insurance Specialist/Medical Biller, 4.0