Jennifer Gomez
Palmdale
Summary
Dedicated healthcare operations professional with 15+ years of experience in eligibility, enrollment, referral management, appointment scheduling, and member/provider relations. Proven expertise in streamlining processes, resolving escalations, and ensuring compliance with Medicare, Medicaid, and commercial health plan regulations. Recognized for accuracy, attention to detail, and ability to thrive in high-volume, deadline-driven environments. Bilingual in English and Spanish.
Overview
20
20
years of professional experience
4009
4009
years of post-secondary education
Work History
Referral Specialist
Centene/ Healthnet
Woodland Hills
06.2015 - 09.2025
- Managed inpatient hospital notifications, ensuring accuracy and compliance across multiple medical management systems.
- Conducted telephonic outreach to providers and members to coordinate care and verify case details.
- Utilized CPT codes to review, validate, and process non-clinical claims in alignment with medical management guidelines.
- Supported clinical teams by routing cases to appropriate reviewers (UMC, RN) in a timely manner.
- Performed non-clinical claim reviews and documented findings to support medical management functions.
- Served as a liaison between members, providers, and Health Net to resolve escalations and improve service outcomes.
Medicare Outreach Specialist
Centene/ Healthent
Woodland Hills
03.2014 - 06.2015
- Perform outbound calls to engage patients of practices and health systems in a discussion about the benefits of HealthNet, the Medicare program, and tech-enabled services.
- The follow-up care plan for members needs to include scheduling appointments or enrolling members in programs.
- Conducted surveys to gather feedback on community health services and programs offered.
- Scheduled and coordinated appointments for seniors, enhancing access to healthcare services and improving overall patient satisfaction.
Eligibility Representative III (Team Auditor)
Centene/ Healthnet
Woodland Hills
07.2009 - 03.2014
- Audited enrollments, disenrollments, and member communications across Medicare Supplement, Employer Group, COB/PDP, and MA/MAPD lines of business, maintaining 98%+ accuracy.
- Trained and supported team members on proper enrollment processing and compliance procedures.
- Resolved escalated enrollment issues, and managed discrepancy reports to ensure timely resolution.
Eligibility Representative I/II
Centene / Healthnet
Woodland Hills
03.2006 - 07.2009
- Processed Medicare Supplement, Employer Group, and COB/PDP enrollments while ensuring strict adherence to regulatory compliance timelines.
- Handled escalated issues from members, providers, and account representatives.
- Researched and resolved discrepancies, improving the accuracy of eligibility records.
- Coordinated provider and member outreach to clarify and resolve enrollment-related concerns.
- Trained and mentored junior staff on data entry best practices, contributing to team knowledge and improving productivity.
- Reviewed and validated data entries to ensure accuracy and compliance with established quality protocols, enhancing overall data integrity.
Document Control Technician
Centene/ Healthnet
Woodland Hills
09.2005 - 03.2006
- Archived, scanned, and maintained accurate member correspondence records.
- Processed return mail and updated contact information in Health Net systems.
- Assisted with departmental projects to support compliance and operational efficiency.
Education
Dental Assistant -
Concorde Career College
North Hollywood, CAHigh School Diploma -
First Lutheran High School
Sylmar, CASome College (No Degree) -
Los Angeles Valley College
Van Nuys, CASkills
- Medical management
- Telephonic outreach
- Claim documentation
- Compliance auditing
- Enrollment processing
- Care coordination
- Insurance verification
Education and Training
other,other,other
Languages
Spanish
References
References available upon request.
Timeline
Referral Specialist
Centene/ Healthnet
06.2015 - 09.2025
Medicare Outreach Specialist
Centene/ Healthent
03.2014 - 06.2015
Eligibility Representative III (Team Auditor)
Centene/ Healthnet
07.2009 - 03.2014
Eligibility Representative I/II
Centene / Healthnet
03.2006 - 07.2009
Document Control Technician
Centene/ Healthnet
09.2005 - 03.2006
Dental Assistant -
Concorde Career College
High School Diploma -
First Lutheran High School
Some College (No Degree) -
Los Angeles Valley College