GIOVANNI SANCHEZ
Haines City,FL
Summary
Highly detail-oriented with strong background in eligibility determination, documentation review, and regulatory compliance. Possesses robust skills in data analysis, case management, and customer service, ensuring accurate and timely processing of applications. Demonstrates conscientious approach to work, maintaining high standards of accuracy and efficiency.
Overview
7
7
years of professional experience
Work History
Patient Care Representative
Carrum health
12.2024 - Current
- Remote
- Trained new employees on proper protocols related to patient care services, using instructional techniques effectively.
- Successfully maintained a high level of confidentiality while dealing with sensitive medical information, highlighting discretion and professionalism.
- Provided excellent customer service to patients and families, demonstrating strong interpersonal skills.
- Coordinated between doctors, nurses, and other staff members to ensure quality patient care, exhibiting strong communication skills.
- Assisted in the implementation of new processes for patient care, displaying problem-solving abilities.
- Used computer and job-related software to compile and record medical charts and reports.
- Protected patient rights by maintaining medical and financial information confidentiality in accordance with HIPAA.
- Answer Chat and messages via email, fax
- Daily outreach calls to patients
Medicaid Eligibility Specialist
Approhealth/Adventhealth
12.2021 - 12.2024
- Established and maintained multiple electronic files to conduct regular reviews and updates.
- Responded promptly to phone calls and emails from clients seeking assistance or answers to questions.
- Communicated with others to obtain and verify eligibility information.
- Assisting with Medicaid, ICP and disability applications
- Determining program eligibility in accordance with current regulations
- Daily outreach calls to patients to establish, renew or maintain coverage
- Billing and data entry
- Interviewed applicants to obtain and verify information to determine eligibility.
- Maintained a high level of confidentiality when dealing with sensitive information related to clients' cases.
- Approved or denied applications, informing applicants within required time frames.
Team lead care coordinator /Case manager
Cohort Intelligence
06.2020 - 10.2021
- Remote
- Collaborated closely with other community organizations to secure resources for clients.
- Developing and coordinating health care programs
- Handling patient case management and education
- Training staff
- Developing patient goals and monitoring
- Knowledge with several EMR systems
- Verify insurance~ Medicaid, Medicare, Commercial
- Imputing billing code
- Daily outreach calls to patients
- Discuss and improve health plans with patients
Member Service Representative
Prime Therapeutics
10.2018 - 07.2020
- Handle inbound calls from members, pharmacists, physicians
- Verify Insurance claims
- Assist with quality Assurance
- Initiate prior authorizations
- Claim processing
- Followed up promptly on all unresolved cases from previous shifts.
- Built relationships with members through quality interactions that exceeded expectations.
- Made appropriate account corrections to resolve customer problems.
- Call center setting
Education
Phlebotomy - Medical
Med-Cert
Ohio12.2016
Medical Assisting - undefined
Med-Cert
OH03.2015
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James Ford Rhodes High School
Cleveland, OH06.2005
Skills
- Medicaid knowledge
- Documentation and paperwork
- Microsoft Office
- Data Entry
- Bilingual
- EPIC, RUMBA, MSA, TOOLBOX, AS400
- Telephone Etiquette
- Documentation And Reporting
- Effective communication skills
- Verbal Communication
- Problem-solving abilities
- Reliabilityy
- Teamwork and Collaboration
- Outreach calls
- Virtual chat and email
- Call center setting
- Leadership
- Telephone etiquette
- Government relations
- Benefits administration
- Public assistance
- Appointment scheduling
- Eligibility procedures
Timeline
Patient Care Representative
Carrum health
12.2024 - Current
Medicaid Eligibility Specialist
Approhealth/Adventhealth
12.2021 - 12.2024
Team lead care coordinator /Case manager
Cohort Intelligence
06.2020 - 10.2021
Member Service Representative
Prime Therapeutics
10.2018 - 07.2020
Phlebotomy - Medical
Med-Cert
Medical Assisting - undefined
Med-Cert
undefined
James Ford Rhodes High School