JANECE GOULD
Warrenton,MO
Summary
A highly accountable and proactive worker, consistently demonstrating a strong sense of ownership and initiative. Known for making quick and effective decisions while maintaining a high standard of customer service. Exceptional at meeting client timelines and driven by a goal-oriented mindset, consistently striving for achievements. A well-rounded and trustworthy individual who consistently delivers results.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Resolution Specialist
MTM, Medical Transportation Management
12.2018 - Current
- Analyzed root causes of recurring issues to implement preventive measures, reducing the number of future complaints.
- Assisted colleagues in navigating challenging situations by sharing expertise and offering guidance when requested or needed.
- Maintained detailed records of all interactions and resolutions for future reference and analysis purposes, improving overall efficiency in handling similar cases down the road.
- Managed high volumes of customer inquiries for efficient resolution, enhancing overall client experience.
- Capable of generating and modifying reports to fulfill client requirements as per contractual agreements
- Efficiently handle customer complaints, conduct thorough investigations, and offer effective solutions
- Accurately annotate member files with the appropriate codes for reporting
- Assess and report to the health plan regarding incidents and accidents involving members
- Maintain regular and clear communication with clients through email
- Establish and preserve a positive relationship with the client
- Comply with stringent deadlines
- Adept at operating effectively in a fast-paced and high-stress environment.
Interim Trainer
MTM, Medical Transportation Management
10.2023 - 01.2024
- Mentored new hires, resulting in stronger staff development and increased productivity.
- Provided one-on-one mentoring to help individuals reach their full potential within the organization.
- Coached employees on best practices, providing constructive feedback to support their professional growth.
- Evaluated the effectiveness of training initiatives by tracking participant progress and gathering feedback for continuous improvement.
- Participated in Migration Training.
- Evaluated scores and offered feedback to supervisors.
Utilization Specialist/ Support Representative
MTM, Medical Transportation Management
05.2017 - 12.2018
- Managed numerous reports, including the Ancillary Eligibility Report, Recurring Trip Report for dialysis, Over Mileage Report, Drug Rehab, and Service Member Portal (SMP).
- Oversaw Care Managed Members - Addressed all transportation requests and related concerns.
- Handled ancillary requests such as meals, gas reimbursement, hotel bookings, and flights.
- Updated workflow processes.
Proposed ideas to enhance process efficiency and workflow. - Collected holiday schedules from dialysis facilities and updated the information in the AS400 system accordingly.
- Verified and extended recurring trips for dialysis members.
- Addressed health plan issues before they escalated to formal complaints.
- Processed and dispatched Distance Verification Forms, Level of Need forms, and Parental Consent forms.
Ambulance/ Stretcher Specialist
MTM, Medical Transportation Management
08.2016 - 05.2017
- Obtained necessary information for trip authorization
- Ability to assess medical necessity of the member and select the appropriate mode of transport
- Aided in entering post authorizations for claims
- Processed and dispatched the requisite authorization forms for stretcher/ambulance trips.
Short Notice Specialist
MTM, Medical Transportation Management
09.2013 - 08.2016
- Successfully scheduled multiple trips within a tight deadline
- Aided in organizing trips across various states
- Established a strong rapport with providers and facilities
- Engaged with members to resolve transportation issues and discuss travel arrangements
Customer Service Representative
MTM, Medical Transportation Management
03.2013 - 09.2013
- Obliged to HIPAA policy
- Met daily guidelines
- Delivered exceptional customer service
- Facilitated trip scheduling across multiple states
- Resolved calls by addressing member concerns effectively
- Provided education on MTM processes
Education
No Degree - Business
Moberly Area Community College
Columbia, MO01.2010
High School Diploma -
Mexico Senior High
Mexico, MO01.2010
Skills
- Goal-oriented
- Positive and friendly demeanor
- Conflict resolution skills
- De-Escalation Techniques
- Computer Office Assistant Experience
- Customer service background
- Proficient in Microsoft software, Adobe software, Sharepoint, Power BI, Verint, Five9, AS400
- Detail Oriented
- Ability to prioritize workload
- Works well as part of a team
- Articulate and well-spoken
- Ability to multitask in fast-paced environment
- Highly Organized
- Energetic, friendly, and enthusiastic
- Deadline-driven
- High Accuracy
- Documentation expertise
- Problem-Solving
- Time Management
Certification
I participated in the year-long MTM mentorship program, Bench, in 2023 and graduated in December of that year. Throughout the program, we were tasked with selecting an MTM process to enhance by developing a SIPOC, VOC, and CTQ chart.
Timeline
Interim Trainer
MTM, Medical Transportation Management
10.2023 - 01.2024
Resolution Specialist
MTM, Medical Transportation Management
12.2018 - Current
Utilization Specialist/ Support Representative
MTM, Medical Transportation Management
05.2017 - 12.2018
Ambulance/ Stretcher Specialist
MTM, Medical Transportation Management
08.2016 - 05.2017
Short Notice Specialist
MTM, Medical Transportation Management
09.2013 - 08.2016
Customer Service Representative
MTM, Medical Transportation Management
03.2013 - 09.2013
No Degree - Business
Moberly Area Community College
High School Diploma -
Mexico Senior High
I participated in the year-long MTM mentorship program, Bench, in 2023 and graduated in December of that year. Throughout the program, we were tasked with selecting an MTM process to enhance by developing a SIPOC, VOC, and CTQ chart.
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