Lucinda Gelardo
Marrero,LA
Summary
Energetic and successful at motivating and building positive team dynamics to accomplish goals. Dedicated to open, communicative culture where employees feel empowered to contribute to company's success.
Overview
27
27
years of professional experience
Work History
Special Operations Rep 4
Humana
11.2023 - Current
- Provided valuable input during team meetings, resulting in the identification of new opportunities for growth and development within the organization.
- Collaborated with cross-functional teams to meet business needs
- Maintained compliance with regulatory requirements by staying current on industry standards and guidelines.
- Demonstrated exceptional problem-solving skills when faced with unique or challenging cases, resulting in successful resolutions.
- Promoted a culture of continuous learning and development within the Grievance Appeals team, encouraging skill growth and knowledge sharing.
- Conducted thorough investigations for complex cases, ensuring fair and accurate outcomes.
- Acted as a departmental resource on Post appeals matters.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Strategized with fellow teammates on how best to tackle complex challenges while maintaining focus on collective goals.
Grievance & Appeals Specialist
Humana
08.2021 - 11.2023
- Medicare and Medicare/Medicaid Dual plans
- Assist members and practitioners via phone or face-to-face
- Investigates and resolves member and practitioner issues
- Decisions cases by utilizing methods, tactics, and processes for completing administrative tasks/projects
- Regularly exercise discretion and judgement in prioritizing requests
- Interpreting and adapting procedures, processes, and techniques
- Work under limited guidance due to experience/breadth and depth of knowledge
Inbound Call Contact/PCC
Humana
10.2019 - 08.2021
- Subject Matter Expert
- Trained for Medicaid, Individual Medicare, Group Medicare and Medicare Supplement plans for Providers and Members
- Communicate Claims information
- Claim corrections sent to be reprocessed
- Verified Eligibility/Benefits
- Authorization information
- Routed calls to appropriate departments
FronT Desk/Medical Receptionist
Audubon Dermatology
01.2019 - 07.2019
- Front Desk Lead
- Schedule Patient appointments
- Ensure patient demographic and insurance information is current
- Answered phones
- Worked within NexTech
- Received Patients for appointments
- Patient Payments at check out
- Benefit information and verification
Blue Cross and Blue Shield/Robert Driscoll-agent
10.2014 - 01.2017
- Assistant Office Manager
- Maintained files and created files for new clients
- Answered phones
- First point of contact for clients
- Worked on Coding/Auth issues for clients
- Maintained office equipment
- Made office supply orders
Administrative Assistant/Archbishop Shaw High School
Marrero
10.2008 - 01.2009
- Secretarial Supervisor
- Maintained Student Records
- Secretarial work for the Vice Principal of Academics
- Maintained the Links System
Apple Expert/ Best Buy
Harvey
10.2007 - 06.2008
- Acting Supervisor of the Computer department
- Ensure functionality of product
- Ensure product pricing was correct and visible
- Ensure stocking of the product was accurate
Executive Assistant for the managing partner/Ostendorf, Tate, Barnett & Wells
New Orleans
10.2003 - 06.2004
- Supervisor of Secretaries and Receptionist
- Maintain personal and business appointments
- Prepared legal documents
- Business and personal files
- Maintained entertainment business affairs
- First point of contact for clients
Administrative Assistant/ Marrero Christian High School
Marrero
06.1997 - 06.2000
- Secretary Supervisor
- Maintain business appointments
- First point of contact for parents
- Maintained student records
Education
Certificate of General Education -
Delgado Community College
01.2016
High school diploma -
John Ehret high school
01.1996
Skills
- Proficient in Microsoft office, email platforms, Internet platforms and above average knowledge of computer and operating systems
- Goal-oriented mindset
- Data entry proficiency
- Performance Improvement
- Case analysis
- Policy Knowledge
- Workflow Management
- Issue Identification
- Objective Evaluation
- Organizational abilities
- Strong analytical skills
- Medical coding knowledge
- Documentation expertise
- Teamwork and Collaboration
- Attention to Detail
- Organizing and Prioritizing Work
- Critical Thinking
- Active Listening
- Decision-Making
- Medical Terminology
- Claims Processing
- Reporting skills
- Denied claims identification
- Eligibility Determination
References
References are available upon request
Timeline
Special Operations Rep 4
Humana
11.2023 - Current
Grievance & Appeals Specialist
Humana
08.2021 - 11.2023
Inbound Call Contact/PCC
Humana
10.2019 - 08.2021
FronT Desk/Medical Receptionist
Audubon Dermatology
01.2019 - 07.2019
Blue Cross and Blue Shield/Robert Driscoll-agent
10.2014 - 01.2017
Administrative Assistant/Archbishop Shaw High School
Marrero
10.2008 - 01.2009
Apple Expert/ Best Buy
Harvey
10.2007 - 06.2008
Executive Assistant for the managing partner/Ostendorf, Tate, Barnett & Wells
New Orleans
10.2003 - 06.2004
Administrative Assistant/ Marrero Christian High School
Marrero
06.1997 - 06.2000
Certificate of General Education -
Delgado Community College
High school diploma -
John Ehret high school