Work History
Education
Timeline
Generic

Mary Ximenez Gonzaba

San Antonio,Tx

Work History

Substitute Teacher

East Central Independent School District
  • Substitute in all East Central Schools, including Elementary, Jr. High and high school.
  • Followed teachers lesson plans for the day the teacher was out or in trainings, meetings, etc.
  • Worked with special needs students, including individual who needed more help than others.

Admissions Manager

University Hospital Systems
  • Managed staff of 17 employees on admitting patients for inpatient and out-patient procedures.
  • Assisted in training staff when necessary.
  • Gave verbal warnings and wrote up employees who did not follow policies/procedures of the hospital.
  • Conducted monthly staff meetings and listened to concerns, ideas and any updates on policies /procedures.
  • Appealed medical claims for Carelink, (University Hospitals Health Plan).
  • Reported directly to the Director of Admissions.

Sr. Provider Relations Representative

Community First Health Plans (CFHP)
  • Conducted workshops for large audiences educating Dr's and hospitals office and hospital staff on policies and procedures of Community First Health Plans and the requirements of hospitals and Dr's offices on eligibility, authorizations, claims submissions, denials, appeals of claims.
  • Conducted in-services for individual Dr.'s offices and hospitals on policies and procedures eligibility, authorizations, and followed up on medical claims denials.
  • Attend monthly staff meetings with the Director of Provider Relations and the entire Provider Relations staff to learn of any changes to policy/procedures, discuss any problems we may have and work on solutions.
  • Visited Primary Care Provider's monthly, and Specialist's office' quarterly to assure that there are no problems or concerns and to ensure that they are following policies and procedures of CFHP.

Provider Relations Representative

Texas Health Network/Texas Healthcare and Medicaid Plan (TMHP)
  • Conducted in-services for individual providers and Medical Groups of the Medicaid Program, explaining policies/procedures, claims, eligibility, authorizations and general information of the plan.
  • Conducted large Workshop's, with up to 150 in attendance, explaining policies/procedures, claims, eligibility, authorizations and general information of the plan.

Provider Relations Representative

Blue Cross Blue Shield of Texas
  • Conducted in-services for individual providers and Medical Groups of the Medicaid Program, explaining policies/procedures, claims, eligibility, authorizations and general information of the plan.
  • Conducted large Workshop's, with up to 150 in attendance, explaining policies/procedures, claims, eligibility, authorizations and general information of the plan.
  • Visited Primary Care Provider's monthly, to assure that there are no problems, concerns and to ensure that they are following policies and procedures of Blue Cross.

Social Services Technician

Texas Department of Health
  • Educated Providers and staff on the Texas Health Steps Program which consists of Physicals to children in the Medicaid Program.
  • Explained the Program to small groups of recipients of the WIC (Women and Children) program
  • My service area includes counties of Wilson, Karnes, Goliad and Victoria
  • Entered weekly reports explaining my visits, in-services and interactions with Dr's offices, WIC Clinics

Education

Business

Palo Alto College

Business

Our Lady of The Lake University

Education

Southwest Texas State University

Timeline

Education

Southwest Texas State University

Business

Our Lady of The Lake University

Business

Palo Alto College

Social Services Technician

Texas Department of Health

Provider Relations Representative

Blue Cross Blue Shield of Texas

Provider Relations Representative

Texas Health Network/Texas Healthcare and Medicaid Plan (TMHP)

Sr. Provider Relations Representative

Community First Health Plans (CFHP)

Admissions Manager

University Hospital Systems

Substitute Teacher

East Central Independent School District

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Mary Ximenez Gonzaba