Genesis Gonzalez
Davenport
Summary
Detail oriented and highly organized administrative professional with 5 years of experience in the healthcare industry, specializing in prior authorizations, claims processing and handling escalations. Proved ability to navigate complex healthcare systems while maintaining compliance with HIPAA regulations and payer policies. Skilled in managing high-volume workflows, resolving issues efficiently, and delivering exceptional service to patients, providers and internal stakeholders. Adept at using electronic health record (EHR) systems, insurance portals and maintaining accurate documentation. Committed to streamlining administrative processes to improve operational efficiency and patient satisfaction.
Overview
7
7
years of professional experience
Work History
Consumer Access Specialist
AdventHealth
Davenport, FL
12.2025 - Current
- Performs Medicare compliance reviews and issues Advance Beneficiary Notices of Non-coverage as needed.
- Creates accurate estimates for patient financial responsibility and collects payments or establishes payment plans.
- Coordinates with utilization management staff for pre-authorization issues and ensures patients have necessary logistical information.
- Contacts insurance companies to verify eligibility and benefits, and obtains pre-authorizations within established timeframes.
- Registers patients for all services, ensuring accuracy and minimizing duplication of medical records.
- Collects critical demographic information from patients and confirms insurance details.
- Manages communication between clinical, ancillary, and consumer access departments to enhance the patient experience.
- Consistently provides excellent customer service, documenting all patient and insurance representative conversations, including payer decisions and payment arrangements.
- Attends department meetings and promotes positive dialogue within the team.
- Provides coverage for PBX (Switchboard) as needed, including answering phones and transferring calls.
- Performs cashiering functions such as collections and cash reconciliation accurately.
- Scan in all necessary documents ( Insurance card, ID).
Billing Operation Specialist
Centene- Wellcare
Remote, Fl
05.2024 - 08.2025
- Provides timely and appropriate resolutions to escalated issues received from various communication channels.
- Serves as a liaison in maintaining relationships between departments to ensure timely and appropriate issue resolution.
- Supports the documentation, tracking and resolution to all assigned complaints and inquiries in writing and/orby telephone in a timely and professional manner.
- Supports root cause analysis of member/provider issues to identify trends across the enterprise and woks cross functionally with all departments to ensure enterprise-wide solutions.
- Helps to coordinate with contact center to research underlying facts of escalated inquiries, determine validity of complaints and evaluate options to remedy these complaints.
- Research and identify claims payment errors and make appropriate adjustments,
- In some instances, collaborate with the claims department to place paid claims correctly and/or to send claims to the claims department for corrections.
Insurance Verification Coordinator
Acaria Health Specialty Pharmacy
Remote, FL
02.2023 - 05.2024
- Obtain and verify complete insurance information, including the prior authorization process, copay assistance and coordination of benefits.
- Obtain and verify insurance eligibility for services provided and document complete information in system.
- Perform prior authorizations as required by payor source, including procurement of needed documentation by collaborating with physician offices and insurance companies.
- Collect any clinical information such as lab values, diagnosis codes, etc.
- Determine patient’s financial responsibilities as stated by insurance.
- Configure coordination of benefits information on every referral.
- Bill insurance companies for therapies provided.
- Document all pertinent communication with patient, physician, insurance company as it may relate to collection procedures.
- Identify and coordinate patient resources as it pertains to reimbursement, such as copay cards, third party assistance programs, and manufacturer assistance programs.
- Handle inbound calls from patients, physician offices, and/or insurance companies.
- Handle Outbound calls to patients and physician offices when we are ready to schedule delivery for medication.
- Resolve claim rejections for eligibility, coverage, and other issues.
Member Relations Specialist
Matrix Medical Network
Remote, FL
03.2021 - 09.2021
- Make outbound calls to health plan members to coordinate and schedule in-home health assessments.
- During outbound sales calls explain the benefits of health assessments and overcome objections.
- Follow standard policies/practices and work to meet or exceed departmental scheduling key performance goals (ACW, Attendance, Work loss, Schedule adherence, Call quality, etc.)
- Managed customer conflicts and challenging situations by staying calm and accessing internal knowledge bases to develop strategic solutions.
Customer Service Associate
Lowe’s Home Improvement
Clermont, FL
03.2019 - 03.2020
- Delivered fast, friendly and knowledgeable service for routine questions and service complaints.
- Addressed inquiries, resolved customer issues and managed customer relations.
- Educated customers on special pricing opportunities and company offerings.
- Organized and prioritized tasks and activities and worked within strict timeframes and deadlines.
- Handled large amounts of cash and balanced cash drawer daily within prescribed balancing guidelines.
- Fulfill online orders within 30 minutes of them getting into store system. Call customers to update them on their order status.
- Assist customers with credit card applications.
- Assist with payments for Lowes Credit Card Schedule deliveries for appliances or large purchases.
Front Desk Receptionist
Hand and Stone Spa
Clermont, FL
11.2018 - 12.2019
- Welcomed patrons to front desk and engaged in friendly conversations while conducting check-in process.
- Received incoming calls and coordinated with staff to fulfill customer requests.
- Explained policies and procedures to visitors.
- Answered multi-line phone system and managed calls by routing to proper extensions or taking messages.
- Completed basic bookkeeping and document filing.
- Scheduled appointments and maintained and updated appointment calendars.
- Monitored reception area to provide consistently safe, hazard-free environment for customers.
- Maintained client accounts by obtaining, recording and updating personal and financial information.
- Developed key customer relationships to increase sales.
- Maintained current store, product and promotional knowledge to drive consistent sales.
Education
Associate of Arts - Business Administration
Valencia College
Orlando, FL10-2022
Medical Billing And Coding -
Ultimate Medical Academy
Clearwater, FL11-2024
High School Diploma -
East Ridge High School
Clermont05-2018
Skills
- Attention to detail
- Inbound/Outbound Calling
- Billing Operations
- Scheduling
- Knowledge of prior authorizations, Grievance and appeals
- Medical terminology
- Insurance Verification
- Data Entry
- Experience with Epic Health System
Languages
Spanish
Native or Bilingual
English
Native or Bilingual
Timeline
Consumer Access Specialist
AdventHealth
12.2025 - Current
Billing Operation Specialist
Centene- Wellcare
05.2024 - 08.2025
Insurance Verification Coordinator
Acaria Health Specialty Pharmacy
02.2023 - 05.2024
Member Relations Specialist
Matrix Medical Network
03.2021 - 09.2021
Customer Service Associate
Lowe’s Home Improvement
03.2019 - 03.2020
Front Desk Receptionist
Hand and Stone Spa
11.2018 - 12.2019
Associate of Arts - Business Administration
Valencia College
Medical Billing And Coding -
Ultimate Medical Academy
High School Diploma -
East Ridge High School