ANTONIA E. APONTE ORTA, MBA
Villa Carolina Blk ** #6 95 street Carolina, PR 00985
*** **** *** ********* ******, FL 32714
Healthcare executive with career track record of achievement in health insurance service industry planning and directing startup and reorganization strategies in the health industry. Results-driven change agent applying exceptional business and financial acumen to meet ever-evolving market challenges and demands. A proven performer who excels at building relationship channels with providers of services and developing and integrating the model to the organization. Consistent, verifiable record optimizing processes, improving productivity, strengthening revenue and developing cohesive, performance-driven teams. At this moment, works in the hospital industry and manage about 28 employees in the Patient Register area. Professional Experience San Jorge Children’s & Women’s Hospital San Juan, P.R. Patient Register Director 2020 to Present
Promotes by the Hospital to supervise register operations in Admission, Radiology, Laboratory, Emergency Clerks and Subspecialty offices. Supervise operational teams in order to ensure patients records meet non-error standards. Facilitates integrated, proactive management, ensuring compliance with state and federal regulatory and accrediting standards. Manages and evaluates team member performance; provides coaching, counseling, employee development, and recognition; ensures ongoing, appropriate staff training and has responsibility for the selection, orientation and mentoring of new staff. Performs and promotes interdepartmental interactions.
Ensures service levels and maintains customer satisfaction by implementing and monitoring staff productivity and other performance indicators
Implement procedures with collaboration with the administration to impact the revenue cycle.
Assure to maintains operation within budgetary parameters. Interacts with the physicians, hospital staff, outside agencies, patients, and patients’ families/significant other(s) to ensure comprehensive care, while maintaining standard of professional business service
Develop effective communication with the staff about the latest updates from the medical plans or hospital administration.
Has accountability for operational and financial performance of the Register sections San Jorge Children’s Hospital San Juan, P.R.
Emergency Room Supervisor 201*-**-****
Hired by the Hospital to supervise ER operations. Evaluates team member performance; provides coaching, counseling, employee development, and recognition; ensures ongoing, appropriate staff training and has responsibility for the selection, orientation and mentoring of new staff. Performs and promotes interdepartmental interactions in order to achieve revenue and patients satisfaction management goals.
Ensures adequate staffing and service levels and maintains customer satisfaction by implementing and monitoring staff productivity and other performance indicators
Develop and implement policies and procedures in collaboration with senior management
Generates claims metric reports and analyze various monthly reports
Able to perform root cause analysis that may cause claims non-compliance
Maintains operation within budgetary parameters. Interacts with the physicians, hospital staff, outside agencies, patients and patients’ families/significant other(s) to ensure comprehensive care, while maintaining standard of professional business service
Has accountability for operational and financial performance COMMISSIONER OF INSURANCE Cupey, P.R.
Assistant in Claims to Liquidator 2010 to 2012
Hired by the SDM Healthcare Management Liquidator to assist in the liquidation process of Salud Dorada con Medicare. SDM closed operations on December, 2009. Among other pertinent and related tasks assigned by the liquidator, in charge of implementing the process of receiving and processing claims from providers of services based on regulations of the Commissioner of Insurance and the Insurance Code of Puerto Rico. Handle all reporting to liquidator. Supervise claims analysts. SALUD DORADA CON MEDICARE Bayamon, PR
Director of Providers Relations, Contracting 2007 to 2009 Recruited to structure, develop and direct full-service Providers, Claims, Credentialing and Contracting Divisions to strengthen operations, expand market and increase market share for evolving Medicare Advantage market and comply with CMS regulations. Analyze industry trends, design, and implement customer and providers service programs and corporate literature. Interacts with process owners and staff from other areas for compliance and administrative purposes.
SDM Provider’s Network Administrator
Hold full responsibility for providers operations through direct training, leadership and supervision of three Providers Managers, one Credentialing Manager, one Claims Manager, one Contracting Manager and work of 10 representatives across island-wide territories.
Liaison between the IPA’s and SDM, specially for utilization, underwriting and clinical aspects.
Create, establish, monitor’s and validate policies and procedures in order to comply with internal and CMS rules & regulations and match RFP’s with proposals and bids for compliance purposes.
Capitalized on competitive research and market intelligence to define provider’s needs and product development initiatives.
Restructured territories and focused team efforts on qualification of SDM in order to raise the marketing hold imposed by CMS .
Managed expansion project to increase the municipalities that served and the number of the providers in the directory.
Negotiated provider service contract with all local hospitals increasing long-term relationship and provider’s participation in SDM network.
Formulated innovative campaigns to strengthen credibility and providers relationship during first five months and increased provider’s base from 2,000 to 6,700 around the island.
Coordinate with other departments the CMS work plan for audits compliance.
Developed with external consultant’s satisfaction surveys, Project of operational manuals, Projects of primary source verifications processes and other related activities in order to comply with CMS policies, regulations and benchmarks.
Created the contracting Loading Section and Projects to manage the new system QicLink and uploading the provider’s contracts.
In charge of restructuring and supervising the Credentialing Department and implement compliance processes based on CMS rules and regulations.
BLUE CROSS OF PUERTO RICO San Juan, PR
Providers Relations Manager 2004 to 2006
In charge of developing and maintaining the network of providers for the Commercial, Medicare and Medicaid business.
Deployed strategic campaign that led to improved relationships with providers
With a team of 8 representatives, advise and gave support providers
Instrumental during negotiations with providers. Provide accounting, claims cost-effective strategies to providers
Contracted and oriented the prospects providers
Manages individual(s) including but not limited to hires, trains, assigns work, manages & evaluates performance, conducts professional development plans. Ensures that the productivity and actions of that group meet/support the overall operational goals of the department as established by department leadership
Ensures team compliance with departmental policies, regulatory requirements and professional standards; keeps policies and procedures up-to-date and participates in revisions as needed Education
University of the Sacred Heart
BA Communications 1992
Metropolitan University of Puerto Rico
Corporate Sponsored Training
Effective Leadership Program Effectiveness in Manage Care
Supervision, Coaching and Counseling
Total Quality Management
Windows XP/2K, MS Office (Word, Excel, PowerPoint, Publisher, Outlook) and Internet Search Engines REFERENCES
Will be submitted upon request