ANATHALIA ORTIZ
Townsend
Summary
Experienced Clinical Research Data Manager with a robust background in managing and optimizing clinical research infrastructure for novel cell and gene therapies. Demonstrated expertise in ensuring data quality, regulatory compliance, and effective collaboration within multidisciplinary teams. Proven track record in previous roles, including comprehensive claims management, auditing within the healthcare insurance industry, and exceptional customer service and pharmacy operations management.
Overview
11
11
years of professional experience
Work History
Clinical Data Manager
University Of Pennsylvania, CCI
11.2021 - Current
- Conduct expert assessments of data entry needs for high-risk gene and immunotherapy clinical research protocols and implemented case report forms (CRFs) for electronic database system.
- Ensure accurate collection of required research information, including enrollment information, clinical labs/procedures, demographics, infusion details, and response data to effectively capture primary and secondary endpoints and adherence to study protocols.
- Collaborate in development and review of study-specific data management documents, such as Data Management Plans, Case Report Form Completion Guidelines, and sponsor data management standard operating procedures to ensure compliance with industry standards and regulations.
- Collaborate with study teams to amend database and study documents as necessary, incorporating protocol amendments and study endpoint changes. Develop and conduct training for sponsor and site study teams on clinical databases, CRFs, and data entry requirements.
- Successfully oversee data cleaning activities, including reviewing data and generating queries for assigned protocols, while consistently generating accurate metrics on data entry and processing. Provided regular updates to project management to ensure seamless execution of project objectives.
- Interact effectively with various stakeholders, including sponsor/sponsor program managers, project managers, monitors, statisticians, clinical investigators, and other teams to ensure all required data is captured and managed accurately.
Senior Claims/Reconsideration Specialist
Independence Blue Cross
06.2018 - 11.2021
- Completed member appeal reconsiderations of disputed determinations accurately and in timely manner per Federal Office of Personnel Management guidelines. Ensured full and fair independent review was completed for medical necessity.
- Demonstrated expertise in providing comprehensive knowledge and education to internal departments and external providers on complex claims issues such as coding, billing, medical records status, and federal appeals processing. Consistently achieved monthly production performance rating of "High Performer" or better.
- Generated and analyzed data reports to identify and monitor trends for continuous claim errors that could potentially impact performance scorecards. Presented findings and recommended action plans to upper-level management.
- Performed monthly audits to ensure compliance with established internal control procedures by analyzing records, reports, operating practices, and documentation of claim processing.
- Developed and maintained corporate desk procedures and provider response templates to ensure production of high-quality and accurate work.
Lead Client Service Representative
Independence Blue Cross
08.2016 - 06.2018
- Delivered exceptional customer service to members and providers by efficiently managing average of 70 calls per day while meeting or exceeding established call center handle time and quality metrics.
- Proactively educated members and providers on eligible benefits and claims processing practices, consistently surpassing goals and achieving first call resolution (FCR) rate of 90% or higher, as well as exceptional customer satisfaction survey (CSAT) scores.
- Directly assist members with enrollment updates including contact and demographic information, verify HIPAA authorizations, and enrollment of additional dependents.
- Offered support to consumer members by accurately processing ACH premium payments, refund requests, stop payments, check reissues, and addressing billing inquiries related to payment history, billing discrepancies, and policy reinstatement for lapsed policies.
Senior Certified Pharmacy Technician
Walgreen's Pharmacy Flagship
04.2013 - 08.2016
- Efficiently received and processed written and e-scribed prescription refill requests while ensuring accuracy. Proficient in manual and semi-automated prescription filling stations to dispense prescribed medications and labeling.
- Collaborated with management to develop and execute standard operating procedures (SOPs) that yielded most significant reduction in medical waste, costs, and opioid abuse in retail pharmacy district for three consecutive quarters.
- Trained and supervised team of 10 pharmacy interns and technicians, providing guidance and oversight on system software, prescription processing procedures, and adherence to pharmacy laws and best practices.
- Managed pharmacy's inventory by forecasting medication and supply needs, placing and processing orders promptly, verifying receipts, and ensuring removal of outdated drugs.
- Demonstrated proficiency in obtaining and processing patient privacy information in compliance with corporate policies, state and federal laws related to HIPAA.
Education
Bachelor of Science - Health Services Administration
Strayer University
Washington, DC 01.2017 - 2020.05
Skills
Strong knowledge of clinical data management processes, systems, and regulations
Proficiency in Veeva and CTMS EDC applications
Experience in developing and implementing data management plans and protocols
Familiarity with relevant industry standards including FDA and HIPAA regulations
Strong analytical skills and attention to detail
Excellent communication and interpersonal skills with ability to effectively present data and findings to stakeholders
Experience in data cleaning and query management
Ability to manage multiple tasks and priorities in fast-paced environment
Proficiency with Microsoft Office software application (Excel, PowerPoint, Word, Outlook, OneNote), Adobe, and Tableau
Timeline
Clinical Data Manager
University Of Pennsylvania, CCI
11.2021 - Current
Senior Claims/Reconsideration Specialist
Independence Blue Cross
06.2018 - 11.2021
Bachelor of Science - Health Services Administration
Strayer University
01.2017 - 2020.05
Lead Client Service Representative
Independence Blue Cross
08.2016 - 06.2018
Senior Certified Pharmacy Technician
Walgreen's Pharmacy Flagship
04.2013 - 08.2016
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