Priscilla Gonzales
Arlington,Texas
Summary
Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
25
25
years of professional experience
Work History
Medical Management Specialist
Elevance Healthcare
Grand Prairie, Texas
01.2023 - Current
- Responsible for generating approval/denial letters, review letters for errors and mail them out to member and/or facility Outbound calls to facilities
- Translate a portion of letter from English to Spanish as necessary
- Finalize and proof letters before faxing them to confirmed fax numbers while maintaining HIPAA compliance.
- Coordinated insurance eligibility verification, prior authorizations, referrals, and claims processing.
Utilization Management Correspondence Rep
MyNexus (Anthem)
Grand Prairie, Texas
05.2022 - 01.2023
- Responsible for reviewing rationale on authorization denial cases for errors
- Outbound calls to facilities for contact information
- Finalize and proof letters before faxing them to confirmed fax numbers while maintaining HIPAA compliance.
Utilization Management
Anthem
Grand Prairie, Texas
08.2021 - 05.2022
- Call center environment; Processed incoming requests, collection of information needed for review from providers, utilizing scripts to screen basic and complex request for precertification and/or prior authorization; Documented and managed incoming faxes
- Verify benefits and/or eligibility information; Acted as a liaison between Medical Management and internal departments; Respond to telephone and written inquiries from clients, providers and in-house departments; Forward cases for clinical review;
Customer Care Rep II
01.2017 - 08.2021
- Responsible for managing incoming calls, faxes, emails and ePAs related to pharmacy prior authorization
- Refer cases requiring clinical review to a Pharmacist or Medical Director
- Responsible for the identification and data entry of pharmacy prior authorization request
- Analyze problems and provide information/solution
- Conduct clinical screening process
- Develop and maintain positive customer relations and coordinate with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner
- Thoroughly document inquiry outcomes for accurate tracking and analysis
- Research and analyze data to address operational challenges and customer serve issues
- Operate a PC to obtain and extract information; documents information, activities and changes in the database
- Medicaid, Amerigroup, Commercial
Billing and Enrollment Representative
Aetna
Arlington, Texas
01.2008 - 06.2016
- Process accurate and timely eligibility into Aetna systems utilizing Aetna policy guidelines and in accordance with key performance measures and claim/first call resolution
- Provide Members with accurate bills, timely and accurate ID cards and audit certification lists
- Position requires attention to detail and accuracy, problem solving, math and accounting skills, ability to analyze financial information and reports, organizational skills, ability to prioritize tasks/work effectively and strong verbal and written communication skills
Customer Care Representative
Hilton Worldwide
Dallas, Texas
05.2011 - 01.2016
AmerigroupMyNexus
- Maximize the customer satisfaction for HHonors (Hilton Honors) members by responding to the incoming telephone calls pertaining to their accounts, promotional mailings and statements, point accruals, redemption and other aspects of the HHonors program
- Consistently provide top notch service with a focus on reservation sales while ensuring high occupancy rates are achieved.
Front Desk Receptionist
Arlington Medical Clinic
Arlington, Texas
06.2007 - 01.2008
- This position involved data entry as well as customer service skills
- It included answering all incoming calls from a multi-line phone; appointment setting; daily input of patient information; checking patients in/out; keeping daily patient log; prepare charts accordingly
- Also required the verification of medical insurance and cash handling.
- Greeted customers warmly and made them feel welcome.
- Assisted with scheduling appointments for clients and visitors.
- Performed data entry into computer systems to maintain accurate records of customer information.
- Provided administrative support such as filing documents, photocopying and scanning materials.
- Updated customer information in databases regularly to ensure accuracy of records.
- Handled payment processing and provided customers with receipts and proper bills and change.
Telecommunicator/Fire Dispatch
City of Arlington Fire Department
Arlington, Texas
08.2005 - 07.2007
- Answer incoming emergency and non-emergency calls for police, fire, and EMS; processed and updated calls for service in Computer Aided Dispatch (CAD) system; prioritize and dispatch calls to emergency responders and accurately manage unit location; and enter, retrieve and confirm records using the National/Texas Law Enforcement Telecommunications Systems (NLETS/TLETS)
- Data entry; dispatch; keep logs of vehicle tows; attention to detail and deal with irate callers or callers dealing with life threatening situations
- Able to maintain calm and accurately enter information for emergency responders.
- Dispatched police officers to calls for service in a timely manner, utilizing knowledge of jurisdictional boundaries and radio protocol.
- Received and documented emergency calls for service from the public, providing callers with necessary information and assistance.
Cashier
Target
Arlington, Texas
11.2005 - 01.2006
- Customer service; cash handling, process customer transactions; cashier duties
Discrepancy Analyst
Patient Account Services
Irving, Texas
07.2004 - 08.2005
- Ensure discrepancy analysis and process are performed efficiently and effectively; monitoring and resolution of unpaid claims and month-end reports; batch report corrections;
- Identified, researched and resolved discrepancies in financial data.
- Conducted daily reconciliation of accounts to ensure accuracy of records.
- Analyzed financial information to identify trends and anomalies.
Emergency Room Secretary
Medical Center of Arlington
Arlington, Texas
06.2003 - 07.2005
- Assist in supporting patients and medical staff by answering incoming calls, organizing charts and admitting new patients
- Use knowledge of medical terminology and billing to manage office efficiently
- Standard administrative responsibilities such as answering phones, making copies, inputting orders or emergency room patients; maintaining supplies; maintain patient records, break down medical charts for record keeping and coordinate billing.
- Answered incoming calls, responded to inquiries, and directed callers to appropriate personnel.
- Provided administrative support to medical staff members during emergency situations.
- Scheduled tests, lab work or x-rays for patients based on physician orders.
- Compiled and coded patient information or data in appropriate computer system.
- Performed bookkeeping duties, preparing and sending financial statements or bills.
Receptionist/Front Desk
WeeTots Pediatrics
Arlington, Texas
08.1999 - 01.2001
- This position involved data entry as well as customer service skills
- It included answering all incoming calls from a multi-line phone system, appointment setting, daily input of new patient information, checking patients in/out; preparing charts accordingly
- This position also required the verification of medical insurance and cash handling.
- Greeted visitors and provided them with assistance.
- Scheduled appointments for clients, customers, and other visitors.
- Maintained a neat reception area by organizing materials and tidying up furniture.
- Performed data entry tasks into various computer systems accurately and promptly.
- Provided administrative support to staff members including typing letters, filing documents, and scanning and copying documents when necessary.
- Processed customer payments using cash registers or point-of-sale terminals according to company policies and procedures.
- Scheduled and confirmed appointments.
Education
Diploma -
Del Rio High School
06.1991
Some College (No Degree) -
Tarrant County Community College
Arlington, TXSkills
- Bilingual (English/Spanish) read, write, speak
- Excellent oral and written communications
- Type 65wpm
- 10-key
- Microsoft word, excel, outlook and PowerPoint
- Avaya, Cisco
- Medicaid, Medicare, filling
- Data entry
- Record keeping
- Cash handling
- Analytical skills
- Problem solving
- MS Word
- Excel
- FACETS
- MACESS
- ACMP
- AUMI
- Call Center
- Medical Terminology
- Insurance Eligibility And Verification
- Data Entry Experience
- Medicaid Experience
- Customer Service
References
Provided upon request
Languages
Spanish
Native/ Bilingual
Timeline
Medical Management Specialist
Elevance Healthcare
01.2023 - Current
Utilization Management Correspondence Rep
MyNexus (Anthem)
05.2022 - 01.2023
Utilization Management
Anthem
08.2021 - 05.2022
Customer Care Rep II
01.2017 - 08.2021
Customer Care Representative
Hilton Worldwide
05.2011 - 01.2016
Billing and Enrollment Representative
Aetna
01.2008 - 06.2016
Front Desk Receptionist
Arlington Medical Clinic
06.2007 - 01.2008
Cashier
Target
11.2005 - 01.2006
Telecommunicator/Fire Dispatch
City of Arlington Fire Department
08.2005 - 07.2007
Discrepancy Analyst
Patient Account Services
07.2004 - 08.2005
Emergency Room Secretary
Medical Center of Arlington
06.2003 - 07.2005
Receptionist/Front Desk
WeeTots Pediatrics
08.1999 - 01.2001
Diploma -
Del Rio High School
Some College (No Degree) -
Tarrant County Community College
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