Alondra K. Ortiz García
San Juan
Summary
Registered Nurse (BSN) with 4+ years of experience in healthcare operations, clinical documentation review, care coordination, and multidisciplinary collaboration. Skilled in partnering with physicians, healthcare providers, and cross-functional teams to coordinate clinical cases, address documentation needs, and support timely patient access to care. Experienced in EHR/EMR systems, medical necessity review, payer requirements, healthcare compliance, and complex case resolution. Proven Team Lead with strong communication, relationship-building, critical thinking, and problem-solving skills focused on improving care coordination, workflow efficiency, and patient outcomes.
Overview
1
1
Certification
8
8
years of professional experience
Work History
CLINICAL REVIEW SPECIALIST & TEAM LEAD
VIP Medical Group
12.2022 - Current
- Serve as LMN Team Lead by coordinating daily clinical reviews, mentoring team members, supporting complex case resolution, and contributing to workflow improvement initiatives.
- Review clinical documentation to ensure medical necessity, documentation accuracy, payer requirements, and regulatory compliance while identifying barriers affecting case progression.
- Managed multiple high-priority clinical cases, ensuring accurate documentation, regulatory compliance, and quality standards while maintaining effective communication with providers.
- Streamlined communication and resolved documentation barriers by collaborating with Prior Authorization, Insurance Verification, Billing, and Clinical teams to enhance case progression.
- Coordinated complex clinical cases with physicians and cross-functional healthcare teams, addressing documentation needs to expedite patient access to care.
FRAUD CUSTOMER SERVICE REPRESENTATIVE
Conduent
01.2020 - 01.2022
- Managed high-volume customer interactions by resolving complex account concerns, providing accurate solutions, and delivering compassionate, customer-centered support while building trust and positive relationships.
- Collaborated with customers and cross-functional teams to resolve concerns, coordinate effective solutions, and ensure clear communication while maintaining compliance with company policies and procedures.
- Maintained accurate documentation and communicated case updates while fostering trusted relationships through active listening, empathy, and solution-focused communication.
- Prioritized high-volume customer cases in a fast-paced environment, ensuring accuracy, quality standards, and timely issue resolution while delivering exceptional customer service.
Financial Analyst
Primerica
01.2019 - 07.2019
- Assessed client needs and provided personalized guidance through consultative communication and customer-centred support to enhance client satisfaction.
- Educated clients on products, coverage options, and benefits to facilitate informed decision-making and deepen client understanding.
- Built strong client relationships through effective communication, active listening, and timely resolution of concerns to foster trust and loyalty.
Education
Bachelor of Science - Nursing
Universidad del Sagrado Corazón
San Juan, PR06-2024
High School Diploma -
Academia La Milagrosa
01-2017
Skills
- Clinical Documentation Review
- Medical Necessity Review
- Documentation Accuracy
- Medical Records Review
- Utilization Management
- Prior Authorization Collaboration
- Payer guidelines
- Care Coordination
- Case coordination
- EHR/EMR Systems
- Healthcare Operations
- Regulatory Compliance
- Healthcare Compliance (HIPAA)
- Stakeholder communication
- Cross-Functional Collaboration
- Provider management
- Process improvement
- Critical thinking
- Time management
- Relationship Building
Certification
- Registered Nurse (Puerto Rico Board of Nursing)
- Diagnosis Coding: Using ICD-10-CM
- Reimbursement
- Revenue Cycle Management (RCM) in Healthcare
Languages
- English
- Spanish
Timeline
CLINICAL REVIEW SPECIALIST & TEAM LEAD
VIP Medical Group
12.2022 - Current
FRAUD CUSTOMER SERVICE REPRESENTATIVE
Conduent
01.2020 - 01.2022
Financial Analyst
Primerica
01.2019 - 07.2019
Bachelor of Science - Nursing
Universidad del Sagrado Corazón
High School Diploma -
Academia La Milagrosa