Mark Gavia
Austin,TX
Summary
Seasoned Claims Adjudicator III and House Manager with a proven track record at Texas Health and Human Service Commission and Dignity Care Residential Services. Expert in Social Security regulations and medical terminology, demonstrating exceptional client rapport and staff management. Excelled in claims processing, achieving significant efficiency improvements, and mentoring teams for enhanced performance.
Overview
28
28
years of professional experience
Work History
Claims Adjudicator III
Texas Health and Human Service Commission
01.2000 - 11.2024
- Gathered information for Social Securit disability claims by requesting relevant physical or mental medical records.
- Wrote summaries of medical and non-medical evidence that assessed residual mental and physical capacity to work.
- Obtained vocational information from clients and wrote vocational analyses to assess whether claimants could return to past or other work.
- Mentored new hires both formally and informally.
- Supported team members in resolving challenging cases, sharing expertise to foster professional growth among colleagues.
- Built strong relationships with medical consultants to facilitate information gathering for claims processing purposes.
- Maintained detailed records of all claims-related activities, fostering transparency and accountability within the department.
- Identified potential fraud cases through meticulous analysis, referring suspicious activity to appropriate investigative teams for further action.
- Maintained contact with claimants and attorneys to determine claim status.
House Manager/Program Administrator
Dignity Care Residential Services, Inc.
12.1996 - 12.1999
- Worked direct care with individuals with mental disabilities in a residential group home setting.
- Assisted clients with daily living skills, behavior program training, passed medications, scheduled and transportation to various medical appointments and social outings.
- Hired, trained, supervised and fired employees.
- Adapted quickly to last-minute changes in plans or circumstances without compromising on quality or results.
- Documented behavior incidents, training program results and required Medicaid billing.
- Conducted regular meetings with the family/guardians of the residents and various professional consultants.
- Acted as company liaison with Austin Travis County MHMR (now Integral Care), Medicaid auditors and the Department of Protective and Regulatory Services.
Education
Bachelor of Arts - Psychology
The University of Texas
Austin, TX05-1999
High School Diploma -
Pflugerville High School
Pflugerville, TX05-1989
Skills
- Client rapport
- Knowledge of Social Security rules and regulations
- Claims processing documentation
- Knowledge of medical terminology, procedures, anatomy and disease processes
- Use of multiple medical, vocational and case processing software applications
- Microsoft Teams, Microsoft Word, email and Skype
- Multitasking Abilities
- Staff Management
Timeline
Claims Adjudicator III
Texas Health and Human Service Commission
01.2000 - 11.2024
House Manager/Program Administrator
Dignity Care Residential Services, Inc.
12.1996 - 12.1999
Bachelor of Arts - Psychology
The University of Texas
High School Diploma -
Pflugerville High School
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