Gina A. Garcia
San Antonio,TX
Summary
Dynamic professional seeking a challenging position that leverages strong communication skills, adept problem-solving abilities, and a customer-focused mindset. Committed to enhancing client satisfaction and contributing to the success of a forward-thinking team. Proven track record of fostering positive relationships and driving results in fast-paced environments. Eager to bring expertise and enthusiasm to support organizational goals and elevate client experiences.
Overview
26
26
years of professional experience
Work History
Patient Services Representative (PSR) at WellMed
Wellmed/United Health Care/Optum
08.2025 - Current
- Analyzed and confirmed eligibility and benefits on a daily basis to facilitate efficient operations.
- Achieved seamless patient onboarding by scheduling new patient appointments for care establishment and routine follow-ups. Streamlined acute care processes by coordinating x-rays, mammograms, and lab appointments, resulting in improved patient access to necessary services.
- Facilitated generation and follow-up of referrals to ensure continuous patient care.
- Tracked and completed follow-up tasks on daily telephone encounters, adhering to a strict 72-hour response timeframe.
- Compiled and submitted end-of-day balance reports to ensure accurate financial tracking.
- Conducted thorough eligibility checks using EPRG, Availity, and Horizon platforms, enhancing operational efficiency in healthcare services.
- Achieved high client satisfaction by effectively managing inquiries related to UHC, Health Springs, Cigna, BCBS, and Medicare Advantage plans. Enhanced operational efficiency through proactive support and guidance on health insurance options. Fostered strong relationships with clients and insurance providers to ensure seamless service delivery.
- Implemented and managed eClinicalWorks system operations.
Care Navigator
Centene/Superior Health Plan/A-Line
11.2024 - 06.2025
- Developed and coordinated care management activities to improve health outcomes for members in foster care.
- Assessed member needs, developed personalized care plans, educated members and their families about available resources, and coordinated care with providers.
- Evaluated the needs of the member, identified barriers for care, and determined available resources.
- Created and contributed to personalized care plans, to address the specific needs of each member.
- Connected members with relevant community resources, such as housing, employment, education, and other social services.
- Facilitated communication and collaboration between members, their families, healthcare providers, and other relevant stakeholders.
- Represented the member's needs and advocated for their access to appropriate care and services.
- Tracked members progress towards care plan goals and adjusted as needed.
- Maintained accurate and up-to-date records of all care management activities.
Billing/Collections Specialist
Clarity Child Guidance Center
09.2023 - 01.2024
- Performed customer service tasks, such as answering phone calls and resolving patient billing issues.
- Reviewed claims and balances to submit clean corrected claims to submit for processing.
- Collected old and current balances while also assisted in setting up payment plans.
- Responsible for discharging patients that were inpatient and/or outpatient care, also explained patient financial responsibility after insurance paid.
- Verified benefits for outpatient appointments and inpatient admissions.
- Assisted with helping patients apply for financial assistance (charity care) programs that helped pay for mental health care.
Customer Service Representative II
Molina Health Plan
01.2022 - 09.2022
- Performed data Entry of Authorization requests and provider inquiries (Such as: Eligibility, Benefits, Contract status, Diagnosis and treatment requests, Coordination of Benefits determination, hospital census information regarding admissions and discharges, and billing codes.)
Scheduling Programmer Coordinator I
Centene/Superior Health Plan
12.2018 - 01.2022
- Handled PHI/HIPAA regulations and procedures related to scheduling
- Scheduled home assessments for members requesting Personal Attendant Services, to assist with home cleaning and cooking.
- Scheduled assessments for members requesting Day and Activity Health Services, Dental services, Home modifications, Respite services and Living Facility services.
- Verify primary care providers, along with eligibility coverage
- Submitted and secured authorizations for vendors.
- Training of new hires, as well as updating work processes.
Service Coordinator
EO2 Concepts
10.2011 - 01.2017
Service Coordinator
Kinetic Concepts, Inc. (KCI)
01.2000 - 09.2011
Education
High School -
Thomas A Edison High School
San Antonio, TX01-1995
Skills
- Excellent verbal and written communication
- Active listening and empathy
- Problem-solving and conflict resolution
- Patient and provider support
- Insurance claims and referral processing
- Knowledge of ICD-9 and ICD-10 medical coding
- Proficient in Microsoft Word, Excel, and Office applications
- Knowledge of medical terminology
- HIPAA compliance and patient information safeguarding
- Healthcare call center experience
- Prior authorization processing
- Detail-oriented data entry and record management
- Strong organizational and multitasking skills
- Working knowledge of payer guidelines (Medicare, Medicaid, Workers’ Compensation)
- Team collaboration and cross-department coordination
- Proficient in billing software: Delair, MOMS, Allscripts, Athena, Kareo, eClinicalWorks, OnBase, and Claim Audit System (CAS)
Timeline
Patient Services Representative (PSR) at WellMed
Wellmed/United Health Care/Optum
08.2025 - Current
Care Navigator
Centene/Superior Health Plan/A-Line
11.2024 - 06.2025
Billing/Collections Specialist
Clarity Child Guidance Center
09.2023 - 01.2024
Customer Service Representative II
Molina Health Plan
01.2022 - 09.2022
Scheduling Programmer Coordinator I
Centene/Superior Health Plan
12.2018 - 01.2022
Service Coordinator
EO2 Concepts
10.2011 - 01.2017
Service Coordinator
Kinetic Concepts, Inc. (KCI)
01.2000 - 09.2011
High School -
Thomas A Edison High School