Frank Gamboa
Windsor,VT
Summary
Proven professional with exceptional record of achievement in enhancing quality improvement initiatives for billing cycle. Dedicated to team success and solving problems with minimal oversight. Dedicated data entry professional with strong organizational, technical, and analytical skills. Recognized for maintaining superior data accuracy while using independent judgment.
Overview
7
7
years of professional experience
Work History
Reimbursement Specialist
Guardant Health
Remote - Windsor, Vermont
06.2022 - Current
- Expertise in resolving various Medicare and state Medicaid denials.
- Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
- Processing of Varying Traditional State Medicaid prior authorizations
- Contacting Commercial insurance companies to obtain necessary preauthorizations needed for upcoming tests and procedures.
- Provide accurate information to all parties, including patients, insurance providers, healthcare staff and office personnel by using effective written and verbal communication skills through SalesForce.
- Facilitated optimized billing processes and operations that are aligned with Guardant Health’s mission and values.
- Maintained working knowledge of proprietary CPT codes for Guardant Health
Revenue Cycle Specialist /Prior Authorization Specialist
Conifer Healthcare Solutions
Lebanon, NH
06.2019 - 06.2022
- Identified and corrected payment problems involving patients or third-party payers.
- Received and submitted payments, updated account information and provided receipts.
- Set up and monitored payment plans and processed payments.
- Contacted insurance companies to obtain necessary preauthorizations needed for upcoming tests and procedures.
- Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.
- Provided accurate information to all parties, including patients, insurance providers, healthcare staff and office personnel by using effective written and verbal communication skills.
- Coordinated resolutions for issues and appealed denied authorizations.
- Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
- Used Epic to input claim, prior authorization and other important medical data into system.
Front End Assistant Manager
Hannaford Bros. Co.
West Lebanon, NH
01.2018 - 05.2019
- Delivered fast, friendly and knowledgeable service for routine questions and service complaints.
- Established positive rapport with customers, managers and customer service team members to maintain positive and successful work environment.
- Trained and mentored new team members to promote productivity, accuracy and friendly customer service.
- Assisted staff with resolving complex customer issues and implementing targeted solutions.
- Trained new employees on company policies, procedures, techniques and customer service standards.
- Developed and implemented new streamlined protocols to enhance productivity and efficiency
- Revised department schedules to maximize coverage during peak hours.
Education
Some College (No Degree) - Geology And Small Group Communications
Los Angeles Valley College
Van Nuys, CASkills
- Issue research
- Precertification requirements
- Insurance information oversight
- Practitioner order verification
- Understanding of medical terms
- Recordkeeping and data input
- Telephone etiquette
- Work ethic
- Computer skills
- Clerical
- Friendly, positive attitude
- Working collaboratively
- Efficient and Meticulous
- Bilingual (Spanish - Fluent)
Languages
Spanish
Native/ Bilingual
Timeline
Reimbursement Specialist
Guardant Health
06.2022 - Current
Revenue Cycle Specialist /Prior Authorization Specialist
Conifer Healthcare Solutions
06.2019 - 06.2022
Front End Assistant Manager
Hannaford Bros. Co.
01.2018 - 05.2019
Some College (No Degree) - Geology And Small Group Communications
Los Angeles Valley College
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