Overview
Work History
Timeline
Generic
Carla Gomez

Carla Gomez

Overview

25
25
years of professional experience

Work History

Contract Analyst

TEKsystems
Albuquerque
10.2023 - 04.2024
  • Registration of Medicaid Client/ Data Analyst Processing New/Renewable and various Medicaid Categories

Patient Relations Liaison

North Scottsdale Family Medicine
Scottsdale
02.2008 - 04.2010
  • Assisted patients in filling out check-in and payment paperwork
  • Took copayments and compiled daily financial records
  • Routinely collaborated with department managers to correct problems and improve services
  • Assisted in resolving and satisfying client requests and internal operational issues
  • Facilitated timely check-in by greeting visitors and establishing purpose of visits
  • Investigated, provided and submitted information to Quality Department about special incidents, events and complaints.

CEO

Hannibal Professional Services, LLC
Peoria
12.2007 - 04.2009
  • Design and deliver training modules for accreditation URAC
  • Billing on a contract basis for Physicians and RTC
  • Credentialing and Contract Negotiations for Clients
  • Develop legal and regulatory compliance programs
  • Design custom practice management manuals
  • Design marketing campaigns for clients
  • Research and write articles based on industry trends to inform clients
  • Develop and maintain corporate relationships
  • Utilize social media avenues to increase business contacts
  • Maximize B2B networking potential
  • Oversaw daily administrative operations.

Practice Administrator

Cactus Psychiatric Associates
Scottsdale
04.2007 - 02.2008
  • Developed and established policies, procedures and objectives
  • Ensured adequate execution, of compliance issues, and updates
  • Evaluated general and specific business conditions as they related to operational issues and advised the physicians on these matters, then developed organizational objectives, and plans for their achievement
  • Implemented sales of pharmaceuticals to increase revenue for practice
  • Increased revenue by 30% by identifying charges not previously captured and lowered A/R balance
  • Within scope of authority, ensured the development of systems (both manual and automated) to properly support practice-wide activities based upon the needs of the practice
  • Developed and executed organizational procedures and controls to promote communication and adequate information flow within the practice
  • Monitored, analyzed, assessed, and communicated practice progress during weekly meetings
  • Ensured compliance and adherence to the organization's structure, management philosophy, and mission statements
  • Developed strategic and operational plans; managed the financial performance, coordinated physicians' contracts with specific payors and supervised front desk and billing staff
  • Managed day-to-day financial activities, including posting insurance payments, A/R, A/P, Payroll, quarterly taxes, EOM reports, banking, all H/R issues, and credentialing.

Client Relations and Clinical Staff Development Administrator

Physicians' Review Network
Phoenix
02.2003 - 04.2007
  • Actively involved in all phases of the Utilization Review process
  • Oversight for hiring, training case coordinators and support services personnel
  • Supervised both Clinical/, Managed day-to-day department activities: establishing priorities, monitoring supervisors, troubleshooting
  • Maintained and updated client information on the company database
  • Motivated staff by providing environment conducive to open communication and opportunities for professional development
  • Assisted in the development of new policies and procedures
  • Monitored Legal, Regulatory and Compliance issues with company attorney
  • Launched Phy-Rev University Training Module and established the program procedures and guidelines for URAC accreditation
  • Assisted with planning and management of performance improvement initiatives in the organization
  • Welcomed constructive criticism from clients, case managers and physicians and employees for system improvements
  • Performed market research surveys amongst client base to seek feedback on customer service, follow-up methods and quality of completed reports
  • Improved customer service, based on client feedback through the development of new policies and procedures
  • Successfully handled all client related issues
  • Worked with IT department, Report Integrity and Quality Assurance Departments on departmental issues and feasible solutions for implementation and resolution
  • Worked with Medical and Associate Medical Directors for better case management processing
  • Conducted research study on quality of services for URAC accreditation
  • Created and implemented new training program for URAC accreditation
  • Member of Credentialing Committee, Quality Assurance Committee and IT committee and Chairwoman of Staff Development and Education Committee
  • Developed, implemented and revised policies and procedures required to ensure compliance to URAC requirements
  • Audited compliance regulations to standards on a quarterly basis and implemented appropriate interventions to achieve departmental goals
  • Prepared case files for physicians' review or medical director, this included preparation of clinical information and correspondence.

Office Manager

Thunderbird Rd Chiropractic
Glendale
12.2000 - 02.2003
  • Maintained records management systems, billing, coding, A/R and basic bookkeeping work
  • Registered /Scheduled patient appointments for physicians
  • Demonstrated ability to maintain composure and work efficiently, preserving patient confidentiality
  • Performed drug/alcohol testing for potential employees of AZ DOT, and other contracted employers
  • Maintained and purchased office supplies and equipment
  • Posted payments to correct accounts using correct contractual allowance according to specific insurance contract
  • Prepared refunds for patient records and insurance companies for overpayments
  • Explained to patients, charges, services and practice policies regarding payment of bills
  • Set up payment arrangements and monitored accounts per policy and procedures using special reports
  • Handled all incoming mail related to insurance companies in a timely manner and responded to patient requests
  • Performed various clerical duties to expedite the collection process, including medical record requests and patient information
  • Obtained authorization and ensured eligibility.

Administrative Assistant

Physiotherapy Associates, Inc
Memphis
04.1999 - 12.2000
  • Provided administrative support to the Administrator and Associate Chief of Physical Therapy
  • Scheduled and greeted patients, increased productivity through superior patient interaction allowing more staff to evaluate more patients
  • Decreased A/R
  • Maintained new referral tracking system for improved patient care to prevent delays in patient treatment
  • Handled all incoming mail related to insurance companies in a timely manner and responded to patient requests
  • Performed various clerical duties to expedite the collection process, including medical record requests and patient information
  • Performed written and/or verbal inquiries to various payers to reconcile patient accounts
  • Obtained authorization and ensured eligibility of patient insurance coverage.

Timeline

Contract Analyst

TEKsystems
10.2023 - 04.2024

Patient Relations Liaison

North Scottsdale Family Medicine
02.2008 - 04.2010

CEO

Hannibal Professional Services, LLC
12.2007 - 04.2009

Practice Administrator

Cactus Psychiatric Associates
04.2007 - 02.2008

Client Relations and Clinical Staff Development Administrator

Physicians' Review Network
02.2003 - 04.2007

Office Manager

Thunderbird Rd Chiropractic
12.2000 - 02.2003

Administrative Assistant

Physiotherapy Associates, Inc
04.1999 - 12.2000

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Carla Gomez