Journey Gomez
Lakeland
Summary
Dedicated professional with extensive experience in insurance billing and claims management. Known for exceptional problem-solving abilities and strong customer relations skills, consistently resolving complex claims issues and improving operational efficiency in fast-paced environments.
Overview
2027
2027
years of professional experience
Work History
AR Follow Up Denials Specialist
Lakeland Regional Health Medical Center
Lakeland, FL
2025 - Current
- Research and prepare responses for payor requests for additional information or documentation.
- Submits corrected claim rebill requests to the PFS Billing team when necessary to send to the insurance payer with correct information and ensures payment is received and claims are paid per contract
- Research denials and works with other departments such as Coding, Billing, CDM, UM, ect. to resolve denial.
- Submits the insurance reconsideration/appeals with supporting documentation in a timely manner and follow up with insurance to ensure receipt and processing. Follows insurance payer claims and appeals timely filing guidelines.
- Communicate clearly and professionally, in both written and verbal manners with internal personnel, payors, providers, patients, and other authorized representatives in regards to outstanding balances.
- Responsible for adequately working correspondence timely and efficiently (including EOBs, RA’s, denial letters).
- Maintain knowledge of current government and carrier regulations, policies, manuals relevant to the industry.
- Identify and report trends in carrier payments and denials, which includes documentation of actions taken to resolve issues. Follows internal escalation process when necessary.
- Identify complex and aged claims issues and follows internal escalation process appropriately.
- Maintain patient confidentiality and privacy; adheres to HIPAA standards.
Insurance Billing Specialist
Dr. Jenny Edwards Pediatric Dentisr
Riverview, FL
2022 - 2025
- Processed insurance claims accurately and efficiently, ensuring timely reimbursements for pediatric dental services.
- Reviewed patient accounts to verify coverage and resolve billing discrepancies effectively.
- Maintained detailed records of patient transactions using practice management software, enhancing data accuracy.
- Communicated with insurance providers to clarify policy details and expedite claim approvals.
- Verified patient insurance eligibility and benefits for timely processing of claims.
- Assisted in streamlining the insurance verification process, enhancing overall efficiency.
- Conducted thorough audits of insurance claims to ensure compliance with company policies.
Billing Coordinator
Aspen Dental
Lakeland, FL
2018 - 2022
- Processed insurance claims efficiently, ensuring timely and accurate billing procedures.
- Managed patient accounts, verifying insurance information to minimize discrepancies.
- Collaborated with healthcare providers to resolve billing inquiries and claim denials.
- Implemented improvements to billing workflows, enhancing overall operational efficiency.
- Trained new staff on billing systems and best practices for accuracy in submissions.
- Conducted regular audits of billing practices, identifying areas for process improvement.
- Coordinated with insurance carriers to verify patient benefits and coverage, minimizing delays in payment processing.
- Improved client satisfaction by promptly addressing inquiries and resolving disputes regarding insurance billing matters.
- Managed front desk operations, ensuring efficient check-in and check-out processes.
Education
High School Diploma -
Lake Gibson Senior Highschool
Lakeland, FL2014
Skills
- Customer relations
- Expert problem solving
- Analytical thinking
- Documentation management
- Advanced communication
- Active listening
- Critical thinking
- Data entry
- Problem resolution
- Relationship building
- Deadline management
- Attention to detail
Timeline
AR Follow Up Denials Specialist
Lakeland Regional Health Medical Center
2025 - Current
Insurance Billing Specialist
Dr. Jenny Edwards Pediatric Dentisr
2022 - 2025
Billing Coordinator
Aspen Dental
2018 - 2022
High School Diploma -
Lake Gibson Senior Highschool