Nictosha Gaines
Montgomery
Summary
Dedicated hard-working individual looking to experience the role you are offering. I have 11 years of working experience in customer service and support. I am proud of helping and assisting others as well as multi-tasking. I am an expert in computers and a speedy typer. I am reliable at all times. I have no problem learning new roles and training. Hope to hear back
Overview
9
9
years of professional experience
Work History
Patient Care Coordinator
Abax Health
Houston, Texas
02.2026 - Current
- Verify insurance through validity and epic for authorizations, copays, covered benefits, eligibility and claims.
- Knowledge of CPT codes as well as creating inpatient and outpatient referrals.
- Faxed referrals, authorizations, and claims to provider offices to streamline patient processing.
- Scheduled MRI, DEXA, and CT scan appointments for patients
- Notate issues with insurance and correspondence from providers.
- Scan all patient documentation into epic.
- Facilitated communication between patients and medical staff to clarify care instructions.
- Managed electronic health records to maintain accurate patient information.
- Organized follow-up care plans to enhance patient adherence to treatment protocols.
- Processed patient intake information and updated medical records prior to treatment.
CUSTOMER SERVICE ADVOCATE
United Health Care
10.2022 - Current
- Researched assistance requested and offered accurate information to resolve issues and respond to inquiries
- Answered inbound calls to greet and assist customers with various needs and questions
- Resolved customer inquiries, complaints, and issues providing insightful solutions
- Offered products and services to meet customers' needs and goals
- Met and exceeded daily service quality and performance goals
- Researched claims and authorizations
- Contacted doctors offices, pharmacies, and dental offices
- Ordered equipment for members in need
- Discussed benefits of plan member enrolled in
- Discussed denials of claims, authorizations, and appeals
- Filed appeals, grievances, and complaints
- Contacted transportation for members on Medicaid benefits
- Assigned providers for members
- Examined claims forms and other records to determine insurance coverage.
- Reviewed medical, vision and pharmacy claims.
- Reviewed prior authorizations for procedures.
- Navigated through multiple systems to research, resolve and process work assigned.
CLERK II
The State Of Texas Health And Human Services
06.2019 - 10.2022
- Collect confidential information from clients
- Created reports and developed improvements and enhancements to automate records and file systems
- Received and routed business correspondence to correct departments and staff members
- Kept office supplies well organized and sufficiently stocked, placing orders promptly to replenish materials before depleted
- Entered personal data using TIERS, data broker, state portal, and EWMS along with following procedures to keep information private
- Managed multiple projects simultaneously using organizational and analytical skills
- Complete reports for clients and staff over the state of Texas
- Use of Microsoft Teams, Skype, and Outlook
- Maintain awesome energy and relations with coworkers and clients.
- Reviewed medical and dental state claims.
- Investigated SNAP EBT claims for reimbursement.
- Followed up with customers on unresolved issues.
- Coordinated with healthcare providers to verify treatment plans and expenses.
- Negotiated settlements with claimants, achieving favorable outcomes for both parties.
- Followed state medicaid processing procedure for claims and settlements.
CASE AIDE
Harris County
11.2021 - 06.2022
- Maintained communication between youth, family members, and case managers to complete the reunification process
- Promoted and encouraged positive interactions and helped maintain healthy relationships among participants
- Checked in adult probation clients for visits with probation officers
- Administered education tests for adults with no diploma
- Called clients to schedule classes for drug and alcohol, theft, and sex offenses
- Sent files to court for community services
- Verified community service hours
- Notated account of offenders for call-ins
- Created PowerPoints for classes
- Administered information needed for classes
- Added education information in databases
CUSTOMER SERVICE ASSOCIATE
Xerox
06.2017 - 10.2018
- Achieved high satisfaction rating through proactive one-call resolutions of customer issues
- Delivered primary customer support to internal and external customers, ensuring timely and accurate resolution of inquiries
- Provided primary customer support to internal and external customers
- Adhered to HIPAA guidelines to ensure patient confidentiality and compliance.
- Informed customers about special promotions and provided detailed information for various products
- Assisted large volume of customers daily, maintaining positive attitude and prioritizing customer satisfaction
- Educated customers on special promotions and detailed product information, enhancing their purchasing experience
- Maintained accurate and current customer account data with manual forms processing and digital information updates
- Followed all HIPAA guidelines
Education
ASSOCIATE OF APPLIED SCIENCE - LAW
Houston Community College
Houston, TexasHIGH SCHOOL DIPLOMA -
Knowledge First Academy
Missouri City, TXSkills
- Patient Data Management
- Patient Record Management
- Insurance Verification
- Patient Coverage Review
- Claim Submission
- Medicaid Processes
- Healthcare Regulations
- Authorization Coordination
- Denied claims identification
- Records Management
- Documentation Review
- Data entry
- Data Entry Software
- Scheduling
- Patient Scheduling
- Patient Follow-Up
- Government Forms
- Equipment Troubleshooting
- Administrative Support
- File Management
- Organizational Skills
- Microsoft
- Microsoft Outlook
- Outlook
- Customer Service
- Customer Relations
- Call Management
- Decision-Making
- Problem-solving
- Problem Resolution
- Critical Thinking
- Staff Training
- Conflict Resolution
- Administrative Support
- Conflict Resolution
Timeline
Patient Care Coordinator
Abax Health
02.2026 - Current
CUSTOMER SERVICE ADVOCATE
United Health Care
10.2022 - Current
CASE AIDE
Harris County
11.2021 - 06.2022
CLERK II
The State Of Texas Health And Human Services
06.2019 - 10.2022
CUSTOMER SERVICE ASSOCIATE
Xerox
06.2017 - 10.2018
ASSOCIATE OF APPLIED SCIENCE - LAW
Houston Community College
HIGH SCHOOL DIPLOMA -
Knowledge First Academy