Heather Gonzales
Bakersfield,CA
Summary
Experienced and friendly Utilization Representative with a strong background in the behavioral health field. Seeking a similar role that values focus and dedication. Skilled office specialist adept at working with diverse personalities, proficient in both back and front office operations. Patient-focused professional with expertise in comprehensive patient care and collaborative teamwork to address various medical conditions. Known for prioritizing patient needs in high-stress settings, passionate about delivering top-notch medical care with a positive attitude. Proficient in managing labs, lab orders, referrals, and appointment scheduling. Leveraging 17 years of healthcare experience to maintain positive relationships and composure in challenging situations.
Overview
15
15
years of professional experience
Work History
Utilization Review Specialist
Embark Behavioral Health
06.2023 - Current
- Managed a high volume of cases efficiently by prioritizing tasks and maintaining strict deadlines for completion of reviews.
- Maintained regulatory compliance by staying updated on industry standards and guidelines, implementing changes when necessary
- Demonstrated strong analytical skills by interpreting complex medical records and synthesizing relevant information for utilization review purposes.
- Enhanced patient care by conducting thorough utilization reviews and ensuring adherence to treatment plans.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Performed prior authorization review of services requiring notification.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
- Supervised and maintained all utilization review documentation through Best Notes, Avea, Kipu, and Excel
- Conducted training sessions for staff members on best practices in utilization review, fostering a culture of continuous learning and improvement.
Medical Receptionist
Priority Urgent Care
11.2021 - Current
- Coordinated patient scheduling, check-in, check-out and payments for billing.
- Checked patient insurance, demographic and health history to keep information current.
- Organized paperwork such as charts and reports for office and patient needs.
- Managed multi-line phone system and pleasantly greeted patients.
- Kept waiting room neat and organized by stacking magazines, removing trash and cleaning glass.
- Adhered to strict HIPAA guidelines to protect patient privacy.
- Transcribed phone messages and relayed to appropriate personnel.
- Helped patients complete necessary medical forms and documentation.
- Referred and screened patients to make best use of resources, triage staff and serve community members.
- Trained new hires
- Managed master calendar and scheduled appointments for providers based on optimal patient loads and clinician availability.
- Opening and Closing duties; daily deposits, stocking of supplies, pre-register appts, clean, check voicemails.
- Responded to correspondence from insurance companies to verify patient's coverage.
- Maintained current and accurate medical records for patients.
Medical Receptionist
LA Laser And Skin Cancer Of Bakersfield
04.2019 - 10.2021
- Organized paperwork such as charts and reports for office and patient needs.
- Managed master calendar and scheduled appointments for 5 providers based on optimal patient loads and clinician availability.
- Documented patient medical information, case histories and insurance details to facilitate smooth appointments and payment processing.
- Obtained payments from patients and scanned identification and insurance cards.
- Maintained office supplies inventory by checking stock and ordering new supplies as needed.
- Carried out front office duties utilizing data entry skills in framework of medical database.
- Completed skilled administrative work to support all office staff and operational requirements.
Medical Receptionist
Dr. Rafiq
07.2010 - 02.2019
- Scheduled, rescheduled and handled cancelled appointments for over 80 plus patients per day
- Managed office logistics by scheduling appointments, maintaining files and collecting payments.
- Checked patient data including insurance, demographic and health history to ensure all information was current
- Adhered to strict HIPAA guidelines at all times according to company policy
- Ordered all office supplies including ink cartridges, toner and paper
- Instructed patients and family members on proper discharge care
- Performed lab tests and communicated results
- Facilitated timely check-in by greeting visitors and establishing purpose of their visit
Education
Medical Billing And Coding - Health Careers Training
Bakersfield Adult School
Bakersfield, CA2010
High School Diploma -
Stockdale High School
Bakersfield, CA1995
Skills
- Customer service
- Appointment scheduling
- Charting and clinical documentation
- Insurance verification
- Payment collection
- Medical office administration
- EMR / EHR
- Patient privacy and confidentiality
- Medical records management
- Communication skills
- Dermatology training
- Proficient in Quickbooks
- Professional telephone communication
- HIPAA compliance
- Understanding medical necessity criteria
- InterQual guidelines
- Discharge planning coordination
- Documentation and reporting
- Clinical utilization review
- Communication
- Teamwork and collaboration
- Problem-solving
- Time management
- Attention to detail
- Multitasking
- Compassionate and caring
- Reliability
- Effective communication
- Patient and family advocacy
- Healthcare regulations
- Quality improvement
Timeline
Utilization Review Specialist
Embark Behavioral Health
06.2023 - Current
Medical Receptionist
Priority Urgent Care
11.2021 - Current
Medical Receptionist
LA Laser And Skin Cancer Of Bakersfield
04.2019 - 10.2021
Medical Receptionist
Dr. Rafiq
07.2010 - 02.2019
High School Diploma -
Stockdale High School
Medical Billing And Coding - Health Careers Training
Bakersfield Adult School
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