Barbara Karen Gonzalez
Jarrell,TX
Summary
Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Committed to leveraging these qualities to drive team success and contribute to organizational growth.
Overview
13
13
years of professional experience
Work History
Innovative Solutions Manager (ISM)
Access2Care
08.2021 - Current
- Company Overview: Innovative Solutions Manager (ISM)
- Account management for Medicaid and Medicare health plans
- Receive, track, communicate and present data involving significant events and grievances
- Updating and maintaining protocols for each managed health plan
- Create and present monthly operations calls via Power Point presentations to managed health plans that include all aspects of contractual obligations
- Provide value in the data presented
- Understand health plan contracts, as well as various departments within Access2Care to effectively manage the day to day of the client and member needs
- Innovative Solutions Manager (ISM)
Claims/Billing Manager
ModivCare formerly LogistiCare LLC
01.2020 - Current
- Professional communication with staff, facility management and providers regarding payment issues, insurance lapses and recoupments
- Validates transportation payments and submits payment exports weekly
- Monitored billing team operations to maintain correct priorities and verify consistent delivery of highest customer service standards
- Worked with corporate accounting team and general managers to verify billing accuracy through proper invoice review and approval processes
- Compiled data and completed routine reports to keep management informed and aid in financial decision making
- Developed and maintained billing related policies and procedures to keep team operations on track
- Minimized and mitigated fraud risks and other potential losses by managing sound security strategies
Claims Supervisor
LogistiCare LLC
06.2017 - 01.2020
- Create professional development plans for employee improvement including performance efficiency
- Monitor individual performance ensuring it meets expected quality performance objectives
- Assist in employee performance evaluations, promotions, retention and termination activities
- Collaborate with various department heads to maintain and improve claims operational processes
- Facilitate weekly AP exports in the absence of the claims manager
- Resolve payment issues regarding non-payment and adjustments
- Demonstrate quality leadership by ways of positivity, encouragement, employee involvement
Claims Processor/Lead
LogistiCare LLC
12.2012 - 06.2017
- Process a minimum of $20K in claim reimbursements per week
- Communicate with medical facilities and clients in verifying appointments
- Document every account with information on claim forms submitted as well as action taken
- Ensure departmental policies and procedure are followed Submit weekly exports to AP for each check run
Assistant Transportation Coordinator
LogistiCare LLC
03.2012 - 12.2012
- Answered incoming calls from clients regarding transportation needs
- Reached out to transportation providers to acquire ETA for client pick up
- Coordinated and assigned trips for clients to several different transportation providers in the Dallas/Ft
- Worth areas
Education
associate degree -
National American University
Skills
- Proficient interpersonal skills
- Excellent organization skills
- Problem-solving skills
- Ability to prioritize
- Ability to organize
- Ability to coordinate multiple work assignments
- Expert ability to work in diverse settings
- Cultural sensitivity
- Knowledge of billing and claims best practices
- Focus on mileage reimbursement
Featuredaccomplishments
- Recognized by management on outstanding customer service from client letters submitted
- Partnered with internal fraud department to reduce fraudulent claims and increase profit
- Perfected monthly presentations to client satisfaction
Primary Language
English
Native or Bilingual
Secondary Language - ASL
I am fluent in American Sign Language (ASL) as I grew up in a deaf household with 2 deaf parents. I learned body language and facial expression as a means of communicating in addition to the English language. I understand the deaf culture and their way of communicating which helps me in being understanding and open to other cultures and languages.
Timeline
Innovative Solutions Manager (ISM)
Access2Care
08.2021 - Current
Claims/Billing Manager
ModivCare formerly LogistiCare LLC
01.2020 - Current
Claims Supervisor
LogistiCare LLC
06.2017 - 01.2020
Claims Processor/Lead
LogistiCare LLC
12.2012 - 06.2017
Assistant Transportation Coordinator
LogistiCare LLC
03.2012 - 12.2012
associate degree -
National American University
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