Edward Gouveia
Las Vegas
Summary
Compassionate advocate with a versatile background in patient care coordination and insurance verification. Known for strong problem-solving and attention to detail, contributing to improved patient outcomes and efficient healthcare delivery. Ready to leverage expertise in a dynamic healthcare environment.
Overview
2027
2027
years of professional experience
1
1
Certification
Work History
Referral Navigator
Southwest Medical Associates / Optum
Las Vegas
03.2025 - Current
- Guided patients in navigating healthcare services and resources to enhance access to care.
- Coordinated appointment scheduling with medical professionals and staff to ensure timely patient visits.
- Educated patients on insurance benefits and coverage options to empower informed healthcare decisions.
- Provided information regarding treatment plans and healthcare procedures.
- Communicated effectively with diverse patient populations to address concerns.
- Collaborated with interdisciplinary teams to optimize patient care pathways.
- Maintained high level of professionalism and calmness with personnel, even in high-stress situations.
Tier 1 Advocate
United Healthcare, UHG
Las Vegas
10.2024 - 03.2025
- Explained insurance benefits and coverage options to patients, ensuring understanding of their choices.
- Assisted healthcare professionals in verifying patient insurance information promptly.
- Collaborated with billing departments to resolve discrepancies in insurance payments.
- Utilized claims management software to track and manage insurance claims effectively.
- Educated patients on medical billing process and out-of-pocket costs, enhancing financial transparency.
- Researched medical codes used in billing processes to ensure accuracy of documentation.
- Reviewed and processed medical insurance claims to ensure accuracy of information and compliance with established regulations.
- Guided clients in maximizing health care benefits to reduce out-of-pocket expenses, optimizing their financial outcomes.
Patient Care Coordinator
Southwest Medical / Optum
Las Vegas
2022 - 10.2024
- Assisted patients with insurance inquiries, verifying coverage details to facilitate access to care.
- Communicated with healthcare providers to relay patient information promptly.
- Managed electronic health records to ensure data accuracy and confidentiality.
- Collaborated with multidisciplinary teams to enhance patient care processes.
- Handled patient feedback, resolving concerns promptly to enhance patient satisfaction.
- Supported billing processes by providing necessary documentation for claims processing.
- Maintained accurate records of patient care activities, ensuring data integrity in electronic health record systems.
Senior Customer Service Representative
Optum Rx
Las Vegas
04.2022 - 10.2022
- Assisted customers with prescription inquiries and medication information.
- Resolved complex customer issues via effective communication, resulting in improved customer satisfaction.
- Collaborated with internal teams to streamline service processes and enhance customer satisfaction.
- Managed escalated complaints, delivering timely resolutions that strengthened customer loyalty.
- Documented customer interactions accurately in the company's CRM system for future reference.
- Analyzed feedback to identify trends and recommended service delivery improvements, enhancing overall customer experience.
- Handled difficult situations with tact, diplomacy, and professionalism.
- Resolved escalated customer complaints in a timely manner.
General Manager
Crumbl Cookies
Las Vegas
01.2020 - 04.2022
- Supervised daily operations of cookie production and customer service to ensure quality and efficiency.
- Trained staff on product knowledge and operational procedures.
- Managed inventory and ensured stock availability for peak hours.
- Coordinated promotional events to drive customer engagement and increase sales.
- Implemented health and safety standards within the kitchen environment.
- Resolved customer inquiries and complaints to maintain satisfaction levels.
- Scheduled employee shifts to optimize workforce efficiency and coverage.
- Managed daily business operations, overseeing budgeting, staffing, scheduling, inventory control, customer service, and sales to maintain operational effectiveness.
Restaurant Front of House Manager
Planet Hollywood - Restaurant & Bar
Las Vegas
02.2015 - 01.2020
- Managed daily operations of front of house staff and service flow.
- Trained and supervised staff on customer service best practices.
- Coordinated reservations and seating arrangements to maximize guest satisfaction.
- Monitored cleanliness and organization of dining areas and bar sections to maintain high service standards.
- Addressed guest inquiries and resolved service issues promptly.
- Collaborated with kitchen staff to ensure timely food delivery to guests.
- Scheduled shifts and managed payroll for front of house team to ensure adequate staffing and operational efficiency.
- Resolved customer complaints in a professional manner.
- Supported management team by handling customer service during busy hours.
Education
Certificate of Completion - Barber
Hawaii Institute of Hair Design
Honolulu, HI07-2007
High School Diploma -
Henry Perine Baldwin High School
Wailuku, HI06-1994
Skills
- Patient navigation
- Claims management
- Insurance verification
- Electronic health records
- Medical billing processes
- Patient relationship management
- Team collaboration
- Effective communication
- Time management
- Professional demeanor
Certification
BLS Certification
Timeline
Referral Navigator
Southwest Medical Associates / Optum
03.2025 - Current
Tier 1 Advocate
United Healthcare, UHG
10.2024 - 03.2025
Senior Customer Service Representative
Optum Rx
04.2022 - 10.2022
General Manager
Crumbl Cookies
01.2020 - 04.2022
Restaurant Front of House Manager
Planet Hollywood - Restaurant & Bar
02.2015 - 01.2020
Patient Care Coordinator
Southwest Medical / Optum
2022 - 10.2024
Certificate of Completion - Barber
Hawaii Institute of Hair Design
High School Diploma -
Henry Perine Baldwin High School