Kewana Gonzales
Baytown,TX
Summary
Motivated Appeals and Denials Specialist with excellent problem solving abilities. Offering 20+ years of experience in Accounts Receivables and a willingness to take on any challenge. Organized, driven and adaptable professional with successful history managing high caseloads in fast-paced environments. Hardworking and reliable with strong ability in Appeals and Denials. Highly organized, proactive and punctual with team-oriented mentality.
Overview
20
20
years of professional experience
Work History
Appeals and Denials Specialist
Houston Methodist Hospital
Katy, TX
02.2020 - Current
- Effectively manages inventory for Medicare Managed Care Advantage plans in accordance with departmental standards.
- Responds promptly to internal and external customer requests.
- Demonstrates articulate, professional, and effective verbal and written communication skills.
- Reviews accounts, takes appropriate action, and documents per departmental standards. The reason for denial; clinical, administrative, or technical, is clearly stated on the payment documentation.
- Demonstrated leadership by making improvements to work processes and helping to train others.
Payment Review Specialist
Houston Methodist Hospital
Katy, TX
08.2017 - 02.2020
- Coordinates and consolidates payer-specific reimbursement data
- Performs complex patient accounting transactions and documentation
- Provides significant input for and assistance with the implementation of team-oriented process
- Effectively manage assigned A/R inventory
- Approaches problems with an open mind and contributes to solutions
- Assisted with appeals denials, as needed
- Identifies cost saving or revenue opportunities
Accounts Receivable Representative II
Houston Methodist Physician Organization
Houston, TX
12.2015 - 08.2017
- Resolves edits related to billing within established Epic charge review and claim edit work queues to ensure claims are billed appropriately and timely
- Assures accounts are completed and worked at a high level of quality by visually proofreading and monitoring work output
- Review claim processing procedures to ensure all sources are utilized in a cost efficient manner
- Verify patient eligibility within Medicare Novitasphere system
- Notify Manager of any claim issues
- Review claim processing procedures to ensure all sources are utilized in a cost efficient manner
- Worked with little to no Supervision.
Patient Account Collections Specialist IV
Christus Health, TLRA
Houston, TX
08.2013 - 12.2015
- Government
- Provides a highly specialized collection service, utilizing knowledge of all types of high balanced collection techniques and recovery options on Medicare and Government accounts
- Submit adjustments to apply contractual to the accounts to resolve balances
- Review accounts for inaccuracies such as incorrect contractual, misapplied payments, incorrect refunds, etc
- Ensures all account activity is thoroughly documented in Meditech and CUBS
- Identify and resolve IPO’s (issues, problems, and opportunities) related to system, payer, or process issues
- Comply with billing procedures in order to manage electronic rejects, rebills, and late charges on daily basis
- Work with little to no supervision.
Education
Associate of Applied Science - Computer Science
Lee College
Baytown, TX 05.2024
High School diploma -
Crosby High School
01.1992
Skills
- Proficient with Microsoft Office
- Medical terminology
- Medical Collections (Medicare and Medicare Managed Care Advantage)
- Excellent knowledge of Epic
- Exemplary customer service and problem-solving skills
- Quick Learner
- Appeals experience
References
REFERENCES
Available upon request
Timeline
Appeals and Denials Specialist
Houston Methodist Hospital
02.2020 - Current
Payment Review Specialist
Houston Methodist Hospital
08.2017 - 02.2020
Accounts Receivable Representative II
Houston Methodist Physician Organization
12.2015 - 08.2017
Patient Account Collections Specialist IV
Christus Health, TLRA
08.2013 - 12.2015
Associate of Applied Science - Computer Science
Lee College
High School diploma -
Crosby High School
Similar Profiles
RHONDA ANDREWSRHONDA ANDREWS
EVS Housekeeper at Houston Methodist HospitalEVS Housekeeper at Houston Methodist Hospital
Kingsley Okon-ItrechioKingsley Okon-Itrechio
Medical Laboratory Technician at Houston Methodist HospitalMedical Laboratory Technician at Houston Methodist Hospital
Robert SmithRobert Smith
EVS Floor Technician at Houston Methodist HospitalEVS Floor Technician at Houston Methodist Hospital
Tatyana GarzaTatyana Garza
Registered Nurse, Operating Room at Houston Methodist HospitalRegistered Nurse, Operating Room at Houston Methodist Hospital
Jerry MallettJerry Mallett
Lead Journeyman Electrician at Contech, IES, ISC, Burrow Global, KBR, & CB&ILead Journeyman Electrician at Contech, IES, ISC, Burrow Global, KBR, & CB&I