Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Montrece Gomez

Atlanta,GA

Summary

Experienced professional responsible for answering phones, customer inquiries, queries, and questions. Proven leader and self motivator with extensive sales, marketing and prospecting experience.

Healthcare professional with wealth of experience in patient service roles, ready to contribute to dynamic team. Known for effective communication and seamless handling of patient inquiries and administrative duties. Colleagues and patients alike rely on collaborative nature and adaptability to meet diverse needs.

Overview

18
18
years of professional experience
1
1
Certification

Work History

Patient Service Representative (Remote)

Benevis
05.2023 - Current
  • Executed excellent customer service and communication skills by verifying and collecting appropriate information, scheduling and registering and also recording patient data in an expedient and accurate manner.
  • Explained and applied hospital and federal policies and regulations to ensure proper patient care.
  • Utilized knowledge of the healthcare field by explaining insurance coverage benefits and medical care cost to patients.
  • Performed check, and credit transactions for the patient's visit, diagnostic studies and supplies.
  • Managed approximately 30 incoming phone calls and resolved patient inquiries and referred calls to appropriate departments.
  • Verified insurance eligibility and coverage for patients.
  • Handled sensitive patient concerns with professionalism and empathy, fostering an atmosphere of trust within the clinic.

Bartender

Buffalo Wild Wings
01.2023 - 09.2023
  • Provided exceptional customer service in a fast-paced environment, ensuring customer satisfaction and repeat business.
  • Expertly crafted and served a variety of alcoholic and non-alcoholic beverages, maintaining a high standard of presentation and quality.
  • Managed bar inventory, restocking supplies and ensuring proper rotation of stock to minimize waste and ensure product availability.
  • Handled cash transactions, processed payments, and provided accurate change while adhering to financial protocols.
  • Maintained cleanliness and organization of the bar area, following all health and safety regulations.
  • Built rapport with regular customers, delivering personalized service to enhance their experience.

Front Desk Receptionist

Journey Family Chiropractic
06.2022 - 04.2023
  • Greet and check in patients, and collect personal, medical, and insurance information.
  • Schedule, reschedule, and verify patient appointments; schedule appointments with secondary care providers.
  • Coordinate physician schedules and maintain patient flow by communicating patient arrivals or delays.
  • Use EMR software to manage patient records and files; reinforce and uphold patient confidentiality as required by HIPAA and clinic.
  • Manage office and medical supply inventories; receive deliveries and organize supplies in stockrooms and exam rooms.

Account Receivables Specialist Remote

Emory University Hospital
01.2022 - 06.2022
  • Over 10 years of health care experience, including medical terminology and hospital policies and procedures. Remotely handled Customer Service and conflict resolution skills. Proficient with computer applications, including Windows and Word Calculated negotiated provider reimbursement to insure proper reimbursement.
  • Performed daily telephone and Internet contact with insurance providers to discuss status of claim and reimbursement to ensure payment in a timely matter.
  • Researched aging reports for unpaid billed claims.
  • Performed necessary task to have commercial and workers comp EOB's reprocessed to receive the correct total reimbursement.
  • Performed corrections on claims and re-billed as necessary.
  • Performed task on Medicare and Medicaid denials, follow-ups, denials and re-bills.
  • Performed online collection procedures for payment, increasing on-time payments.
  • Maintained and prioritized daily tasks and projects including: unpaid claims, appeals, credit balances.
  • Reviewed monthly accounts receivables, follow up for resolution, insurance contact and claim re-files when necessary.
  • Knowledgeed of oncology billing reimbursement as well as CPT-4, ICD-9, HASPS coding required.

Customer Care Representative

Lust Boutique
01.2013 - 03.2020
  • Women's Clothing Sales Associate
  • Provided a complete shopping experience to all our customers.
  • Provided excellent customer service while on the selling floor, fitting room and front end.
  • Stocked and replenished merchandise when necessary.
  • Received and processed cash, check and credit payments.
  • Recommended, selected and helped locate merchandise based on customers needs and desires.

Front Desk Receptionist

Northside Family Medicine and Urgent Care
03.2019 - 01.2020
  • Answered phone calls in a kind and professional manner as well as routed them to concerned person
  • Advised office manager of the need to order supplies pertinent to front desk functions as well as maintained appropriate inventory levels
  • Scheduled, rescheduled, or canceled patient's appointments both in-person and via telephone
  • Collected co-payments, deductibles or deposits as well as verified insurance coverage, and patient demographics accurately and efficiently
  • Filed and maintained patients' medical records and maintained patients' privacy and confidentiality
  • Operated and maintained standard office equipment such as multi-line telephone, copy and facsimile machines, scanners, and printers
  • Maintained clean and orderly waiting areas in accordance with the established safety regulations or standards
  • Received as well as appropriately distributed and addressed all incoming faxes, mails and other deliveries

PDP Analyst

Humana
06.2013 - 03.2019
  • Processed claim forms, adjudicates for provision of deductibles, co-pays, co-insurance maximums and provider settlements
  • Entered claims data into system
  • Resolved problems resulting from claim settlement
  • Performed audit of randomly selected claims to ensure quality processing
  • Researches claim overpayments and requests funds
  • Followed adjudication policies and procedures to make sure proper payment of claims
  • Provided timely customer service to members, providers, billing departments and other insurance companies on the subject of claims
  • Logged telephone calls in system and followed up on issue

Claims specialist

Humana
01.2012 - 01.2013
  • Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
  • Enhanced customer satisfaction with timely communication, empathy, and clear explanations of claim outcomes.
  • Settled complex claims fairly by applying critical thinking, negotiation skills, and detailed knowledge of insurance policies.
  • Reduced claim processing errors by conducting thorough investigations and accurately interpreting policy details.
  • Improved claim processing efficiency by streamlining workflows and implementing time-saving strategies.

AT&T
01.2007 - 01.2012
  • Customer Service Executive
  • Developed qualified leads for the client.
  • Captured customers and corporations information accurately.
  • Other duties included data cleansing, lead generation, event management, and data profiling.

Education

High school or equivalent -

Pleasure Ridge Park Hs Magnet Career Aca
05-2007

Skills

  • Software troubleshooting
  • Customer Care
  • Serving
  • Accounts receivable
  • Cold calling
  • ICD-9
  • EMR systems
  • POS
  • Medical office experience
  • CSR
  • Medical receptionist
  • Microsoft Word
  • Word processing
  • Travel planning
  • Teaching hospital
  • Hospital experience
  • Medical billing
  • Bar
  • Time management
  • Hospitality
  • Cocktail experience
  • Microsoft Excel
  • Cash handling
  • Debits & credits
  • QuickBooks
  • ICD-10
  • Grammar Experience
  • Front desk
  • Computer literacy
  • Customer Service
  • Inpatient
  • Computer skills
  • Analysis skills
  • ICD coding
  • Clear Enunciation (8 years)
  • Guest relations
  • Windows
  • Office management
  • Customer Support
  • Medical collection
  • Medical records
  • Wine knowledge
  • Microsoft Office
  • Data analysis skills
  • HIPAA
  • Sales
  • CPT coding
  • Web accessibility
  • Medical terminology
  • IT
  • Medical coding
  • Trauma medicine
  • Communication skills
  • Call Center
  • Bartending
  • Customer service (10 years)
  • Conflict management

Certification

  • Life and Health Insurance
  • RHIA
  • Bartender License May 2024 to November 2034
  • Certified Professional Coder
  • ServSafe
  • Food Handler Certification
  • CPR Certification
  • AHIMA
  • Real Estate License
  • Medical Coding Certification
  • Driver's License
  • Certified Coding Associate
  • Certified Coding Specialist
  • RHIT
  • Medical Billing Certification

Timeline

Patient Service Representative (Remote)

Benevis
05.2023 - Current

Bartender

Buffalo Wild Wings
01.2023 - 09.2023

Front Desk Receptionist

Journey Family Chiropractic
06.2022 - 04.2023

Account Receivables Specialist Remote

Emory University Hospital
01.2022 - 06.2022

Front Desk Receptionist

Northside Family Medicine and Urgent Care
03.2019 - 01.2020

PDP Analyst

Humana
06.2013 - 03.2019

Customer Care Representative

Lust Boutique
01.2013 - 03.2020

Claims specialist

Humana
01.2012 - 01.2013

AT&T
01.2007 - 01.2012

High school or equivalent -

Pleasure Ridge Park Hs Magnet Career Aca

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