Delia Gomez
Robstown,Tx
Summary
Hardworking and passionate job seeker with strong organizational skills eager to secure position. Ready to help team achieve company goals. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.
Overview
33
33
years of professional experience
Work History
CLAIMS ANALYST II
DRISCOLL HEALTH PLAN
04.2018 - 08.2023
- Reduced claims processing time by implementing efficient analytical techniques and strategies.
- Enhanced customer satisfaction by resolving complex claims issues in a timely manner.
- Streamlined workflow processes for improved efficiency and reduced claim resolution times.
- Managed high-volume caseloads, prioritizing tasks to ensure timely completion of all claims.
- Conducted thorough investigations into each claim, gathering relevant data and documentation to support decision-making processes.
- Identified trends in claim patterns, providing actionable insights for process improvements and risk mitigation strategies.
- Participated in ongoing training programs to stay current on industry developments and maintain a strong understanding of relevant laws and regulations affecting the claims process.
- Viewed reports regularly to make sure processing was conducted efficiently.
- Maintained claims data in EPIC systems.
- Reviewed questionable claims by conducting agent and claimant interviews to correct omissions and errors.
- Evaluated original investigation reports and documents to resolve secondary concerns.
Mailroom Clerk
EVOLENT HEALTH
02.2013 - 03.2018
- Improved mail processing efficiency by accurately sorting and distributing incoming mail to appropriate departments.
- Maintained a well-organized mailroom, enabling quick retrieval of packages and correspondence for employees.
- Safeguarded sensitive information by properly handling confidential documents according to company policies and procedures.
- Multitasked effectively in a fast-paced environment, prioritizing tasks appropriately to meet daily deadlines consistently.
- Created detailed documentation for package tracking purposes, allowing recipients to monitor the status of their shipments in real time.
- Offered support to other departments when needed, demonstrating flexibility and teamwork in achieving organizational goals.
- Developed strategies to speed up mail mail sorting and delivery processes.
- Updated and maintained mailing lists and provider records.
OFFICE ASSISTANT
MICHAEL S. LOVOI MD., PA
06.2012 - 02.2013
- Enhanced office efficiency by managing schedules, organizing files, and maintaining a clean workspace.
- Expedited document processing with accurate data entry and timely filing.
- Increased customer satisfaction by providing professional and courteous front desk support.
- Reduced operational costs through effective inventory management and negotiation with vendors.
- Facilitated smooth operations by efficiently handling incoming mail, phone calls, and visitor inquiries.
- Welcomed office visitors and alerted staff to arrivals of scheduled appointments.
- Strengthened office organization by implementing new filing systems and digital record-keeping practices.
Medical Office Assistant
ABIMAEL PEREZ MD., PA
09.2005 - 05.2010
- Enhanced office efficiency by managing schedules, organizing files, and maintaining a clean workspace.
- Collected copays and co insurance
- Facilitated smooth operations by efficiently handling incoming mail, phone calls, and visitor inquiries.
- Maintained confidentiality in handling sensitive information while performing administrative tasks.
- Assisted physicians in providing high-quality care, completing insurance forms and handling referrals promptly.
- Maintained strict compliance with HIPAA regulations, ensuring the confidentiality of sensitive patient information.
- Managed the efficient flow of medical records by confirming accuracy, scanning documents into the EMR system, and securely storing physical copies.
- Updated patient information and insurance details for accurate electronic medical records.
- Coordinated patient scheduling, check-in, check-out and payments for billing.
- Completed clerical tasks such as filing, copying, and distributing mail.
- Interacted with customers by phone, email, or in-person to provide information.
- Input data into spreadsheets and databases.
- Answered and managed incoming and outgoing calls while recording accurate messages for distribution to office staff.
OFFICE ASSISTANT
MICHAEL J. SCHIOP DPM
05.2002 - 05.2005
- Improved patient satisfaction by efficiently scheduling appointments and managing patient records.
- Enhanced patient care with timely and accurate data entry of medical histories, prescriptions, and lab results.
- Assisted physicians in providing high-quality care, completing insurance forms and handling referrals promptly.
- Reduced wait times for patients through effective appointment scheduling and efficient front desk management.
- Assisted physicians with medical procedures, ensuring high-quality patient care and safety.
- Ensured compliance with HIPAA regulations through meticulous handling of sensitive patient information.
- Expedited referrals to specialists by coordinating appointments, sharing pertinent medical history, and obtaining necessary authorizations from insurance providers.
- Assisted in maintaining adequate inventory levels of medical supplies through diligent tracking and cost-effective ordering practices.
- Facilitated prompt prescription refills for patients by communicating with pharmacies on behalf of physicians.
- Assisted office manager with tracking inventory and restocking examination rooms and stations.
- Transmitted paperwork between providers and insurance companies to facilitate billing.
- Sanitized, restocked, and organized exam rooms and medical equipment.
- Directed patients to exam rooms, fielded questions, and prepared for physician examinations.
- Verified patient insurance coverage and collected required co-payments.
OFFICE ASSISTANT
PAULS. KRUSZKA DPM
07.1990 - 05.2002
- Enhanced patient experience by efficiently managing front and back office tasks, improving overall clinic flow.
- Assisted physicians with medical procedures, ensuring optimal patient care and satisfaction.
- Maintained accurate patient records, contributing to a well-organized and efficient medical practice.
- Trained new medical assistants on best practices, ensuring consistent quality of care across the team.
- Developed strong relationships with insurance companies to expedite claims processing and enhance overall patient satisfaction.
- Ensured compliance with OSHA guidelines by maintaining a clean work environment.
- Triaged incoming calls for provider to determine callers' needs for immediate appointments or scheduled visits.
- Protected patients and staff from infection risks by routinely cleaning and disinfecting common areas and patient rooms.
- Assisted physicians and nurses with clinical procedures following safe practices.
Education
MEDICAL ASSISTANT -
CBM EDUCATION CENTER
01.1990
DIPLOMA -
ROBSTOWN HIGH SCHOOL
01.1989
Skills
- Claims
- Interpersonal and written communication
- Claim investigation
- Claims review
- Critical Thinking
- Proficient in Microsoft
- Insurance Verification
- Medical coding knowledge
- Medical Billing Support
- Data Entry
- Medical Terminology
- Medical terminology knowledge
Timeline
CLAIMS ANALYST II
DRISCOLL HEALTH PLAN
04.2018 - 08.2023
Mailroom Clerk
EVOLENT HEALTH
02.2013 - 03.2018
OFFICE ASSISTANT
MICHAEL S. LOVOI MD., PA
06.2012 - 02.2013
Medical Office Assistant
ABIMAEL PEREZ MD., PA
09.2005 - 05.2010
OFFICE ASSISTANT
MICHAEL J. SCHIOP DPM
05.2002 - 05.2005
OFFICE ASSISTANT
PAULS. KRUSZKA DPM
07.1990 - 05.2002
MEDICAL ASSISTANT -
CBM EDUCATION CENTER
DIPLOMA -
ROBSTOWN HIGH SCHOOL