April A Gomez

Manage and resolve member grievances and appeals through comprehensive analysis of clinical documentation, ensuring adherence to regulatory and organizational policies.

Deliver final determinations based on clinical review, organizational guidelines, and coordination with cross-functional teams including clinicians and compliance partners.

Serve as a key liaison for members and providers, offering support via phone or in-person to address concerns, uphold service standards, and drive quality-related goals.

Conduct advanced administrative and operational tasks with a high degree of accuracy, often under minimal supervision.

Regularly apply independent judgment and discretion to prioritize requests, interpret procedures, and adapt processes to meet evolving demands.

Utilize intermediate mathematical and data analysis skills to support decision-making and track resolution outcomes.

Investigate and resolve complex member and practitioner issues, ensuring timely and effective outcomes in alignment with company policies and member satisfaction.

Recognized for deep understanding of administrative workflows, contributing to process improvements and efficiency initiatives.

• Provide surgical options for new patients, schedule consultations, explain medical benefits and coverage for surgical procedures. Assist surgeons with pre op/ post appointments. Meet with other physicians in San Antonio and surrounding areas to generate new referrals for the surgical and aesthetics office.
• Demonstrate advanced surgical procedures and discuss surgical options in breast cancer surgery. Assist with all front office duties, answers phone, email and fax. Schedule new/ existing patients. Collect copay and past due payments. Input patient chart and scan new medical form, referral, and test results. Schedule surgery at assigned hospital. Verify insurance and initiate the process for surgery approval.
• Develop new relationships for new referrals
• Daily control sheets, payment deposit log
• Receive and respond to telephone calls and messages
• Input new patient info and insurance
• Weekly update meetings with doctor and Ceo
• Insurance authorization/ schedule surgery

• Superior family practice management, advised and supported 15+ staff members, in ultrasound, bone density machine, weight loss, Exec physicals, Sick visits/ chronic care patients, and annual wellness visits for seniors. Front office experience with check-in and check out. End of day reports and daily deposits. HR responsibilities include: weekly staff schedule, approve vacation times, track bi-weekly hours for payroll. Process payroll through benefits and Paychex systems. Interview and onboarding of new staff members. Held monthly staff meetings and planned all holiday/seasonal outings for practice.
• Expert review of the entire practice schedule daily to ensure patient care and services are provided, collect data and ancillary reports for the entire practice. Train staff on new medical procedures or programs. Meet with current and new clinic vendors. Streamline all new procedures and processes for clinical staff and front office staff.
• Clinical experience performing and assisting with medical procedures with hormone pellet insertion, Botox injections, hydro facials, medication administration, performed UA/ toxicology testing, DNA swab samples, collecting laboratory specimens, performing vital signs and intake of patients. Explained medical procedures to patients. Assure patient flow stays on time with daily schedules. Track and order all medical supplies shipped to office.

• Experienced with Pre-op/ post op appointments, patient consulting, EMR system (Practice fusion) and meaningful use reports. Ensured all patient consent forms were signed and dated. Assisted doctor with in office surgeries and procedures.
• Exceptional experience in Initial patient triage, direct patient care and specialized medical care. Review patient’s charts. Educate and advices patient on specific medical care. Maintained stock of medication and medical supplies and scheduled all new and existing patients. Collected co-payments and insurance verification. Orthotic casting, fitting, molds, and cast removal.

• Trained as a surgical technologist, to process donated human tissue into quality reconstructive and sports medicine allograft. PASCO2 technology used to remove blood particles and lipids from sterilized tissues. Data input all donor information and maintain reports of all tissues processed.

• Completed 240 hours of clinical work in Alzheimer’s Center, clinical rotations in Geriatrics and actively participated in unit-based Quality Assurance Program. Sound, ethical and compassionate ability consistent with center protocols, provided behavioral/emotional support and supervision for those with dementia and Alzheimer’s. Worked as part of a team to ensure proper care of body mechanics and safety of patients.

• Completed 240 hours of clinical work in Express Med Clinic - OB/GYN - HIV/AIDS (FFACTS) Clinic - Dermatology - Surgical Dentistry, recorded patients’ medical history, vital statistics and test results in medical records. Provided necessary health education training for patients. Tested glucose and administered injections. Maintained patient charts and confidential files. Delivered high-quality and compassionate treatment to indigent and low-income patient communities.

• Completed 480 hours of clinical work in neurological and orthopedic rehabilitation. Recorded patients’ medical history, vital statistics and test results in medical records. Assisted patients with healing and recovery after surgery. Supported patients with customized patient teaching tools. Worked as part of a team to ensure proper care of body mechanics and safety patients.

• Daily office operations, managing a staff of six employees overseeing duties to include administration, personnel issues, human resources policies and procedures. Authorization of commission sheets and payroll. Oversee inventory and purchases. Data entry for all new customer accounts. Customer service, billing and collections for past due accounts. Review company contracts for customer signatures, dates and monthly fees.