Tanya Gomez
Gulfport,FL
Summary
Reliable and detail-oriented professional with 25+ years clinical and administrative experience. Backed by a solid work history and recognized as dedicated and loyal with a desire for continuous learning. Team approach to providing collaborative business and healthcare services. Uncompromising integrity, work ethic and professionalism. Bilingual - Fluent in Spanish.
Overview
26
26
years of professional experience
Work History
Call Center Supervisor
Bio-Genetics Laboratory
St. Petersburg, FL
01.2021 - Current
- Oversee a staff of 45 to 50 employees.
- Planned and led team meetings to review business results and communicate new and ongoing priorities.
- Monitored daily operations, including call volume, average speed of answer, service levels, customer satisfaction scores, and other key metrics.
- Developed training materials for new hires on how to handle different types of calls effectively.
- Facilitated individual coaching sessions with CSRs to realign productivity goals.
- Delivered constructive call process feedback.
- Resolved escalated customer complaints in an efficient manner while maintaining positive relationships with clients.
- Reviewed employee performance and provided ongoing feedback and coaching to drive performance improvement.
- Trained and supervised new employees to promote overall team productivity and consistent service.
Coverage Consultant (Private Contractor)
Bayfront Hospital Baby Place
St. Petersburg, FL
01.2020 - 01.2021
- Screened uninsured patients for Medicaid benefits.
- Applied online for Medicaid applications for qualifying patients.
- Upload the required documents into the patient's folders.
- Processed birth certificate letters of newborns and updated the birth name into the FLMMIS website.
- Generated PIN activations for newborns on the FLMMIS website.
- Completed Medicaid applications via My Access.
- Processed Emergency Medical Assistance for undocumented patients
- Created new patient accounts and transferred information to the external hospital system.
- Updated approved Medicaid information to internal and external hospital systems.
Patient Advocate
CareValent
St. Petersburg, FL
01.2018 - 01.2020
- Facilitated communication between providers, patients, and family members.
- Updated members on health plan coverage and the status of accepting providers.
- Submitted weekly reports to leadership on accepting providers.
- Reached out to potential providers regarding members' health plan reimbursement rates.
- Complied with all established company policies and procedures while upholding the security and confidentiality of documents and data.
- Submitted the contract agreement to providers and facilities regarding health plan reimbursement rates.
- Worked with patients to appeal insurance decisions and coordinated with providers to resolve problems.
Healthcare Scheduler Specialist
Metro Health and Wellness
St. Petersburg, FL
01.2017 - 01.2018
- Manage the daily operation of behavioral health and medical scheduling for healthcare providers.
- Function as the first point of contact with clients and patients.
- Responsible for scheduling BH counseling and medical appointments for established and new patients.
- Process in office referrals for HRT services on gender identifying clients and patients
- Conduct intake information on walk-in clients requesting behavioral health services.
- Set up appointments, organize paperwork, and distribute information via mail, email, or telephone.
- Offer support to the department through coordination, monitoring, tracking, and reporting information.
- Assistant to the department lead as backup and liaison with assigned duties, services, and projects.
Care Coordinator
Cordant Health Solutions
Tampa, FL
01.2015 - 01.2016
- Coordinated toxicology screenings for Workers' Compensation patients at the request of adjusters and case managers.
- Provided screening kits to physicians offices and labs for the collection of specimens.
- Provided toxicology reports to contracted carriers and physicians offices upon request.
- Collected any changes or updates, and documented all incoming and outgoing calls into the database.
- Communicated test results to authorized carriers via email and/or via telephone.
- Conducted follow-up calls to the physicians office for the status of specimen collections.
- Responsible for coordinating the collection to be performed at the patient's next office visit with the treating physician.
- Met and exceeded the amount of collected specimens required by management monthly.
Credentialing Specialist/Delegation
WellCare
Tampa, FL
01.2005 - 01.2010
- Conducted reviews of providers' credentialing, including new applications, re-credentialing, and ongoing maintenance of provider credentialing.
- Cross-checked the vendor credentialing database with the WellCare database.
- Produced reports, maintained provider changes, and reviewed and filed reports.
- Conducted pre-delegation and annual audits in accordance with the agreement and regulatory requirements.
- Prepared audit reports to ensure provider satisfaction.
- Offering support for the department through coordination, monitoring, tracking, and reporting information.
- Provided quality checks for accuracy, and looked for ways to enhance processes and effectiveness.
Managed Care/Customer Service
Florida Orthopeadic Institute
Tampa, FL
01.2001 - 01.2005
- Managed the daily operations of the front desk in a busy practice, with an average of 52 appointments each week.
- Contacted the State Board licensing offices to verify board certifications for physicians.
- Ensured proper processing and collection of fees and charges.
- Set up appointments, organized paperwork, and distributed information via mail, telephone, and email.
- Handle patients' check-in and check-out, and relay patients' Workers' Compensation status.
- Responsible for organizing, updating charts, and verifying insurance.
- Remained compliant with all healthcare facilities, HMOs, and insurance requirements.
- Functioned as the first point of contact with insurance companies and clients.
Customer Service
Health Plan Services
Tampa, FL
01.1999 - 01.2001
Education
Basic X-Ray Technician - Medical Office Procedures
Ultimate Medical Academy
Tampa, FL01.2011
Skills
- Sensitivity and confidentiality
- Problem solving
- Written communication
- Verbal communication
- Interpersonal communication
- Organization
- Prioritization
- Multi-tasking
- Attention to detail
- Independence
- Minimal direction
- Computer knowledge
- Microsoft Word
- Microsoft Excel
- Microsoft PowerPoint
- Microsoft Outlook
- Data entry
- Typing speed
- Managed care
- Credentialing
- Customer service
- Workers compensation
- Basic X-Ray technician
- Medical office procedures
- Electronic medical management
- Radiation safety
- Positioning and procedures
- Equipment operation
- Maintenance
- Patient care management
- Call monitoring
- Coaching and mentoring
- Training delivery
- Staff motivation
- Medical terminology
- Anatomy and physiology
- HIPAA compliance
- Front office
- Back office
- Scheduling
- Training management
Coremedicalproficiencies
- Managed Care
- Credentialing
- Customer Service
- Workers Compensation
- Basic X-Ray Technician
- Medical Office Procedures
- Medical Assistant
- CPR/BLS
- HIV/AIDS
- First Aid
- Electronic Medical Management (EHR/EMR)
- Radiation Safety and Protection
- Positioning and Procedures
- Equipment Operation and Maintenance
- Patient Care Management
- Clinical Lab Procedures
- Vital Signs
- Medical Terminology
- Anatomy and Physiology
- HIPAA Compliance
- Specimen Collection and Handling
- Urinalysis
- Clinical Techniques
- Minor Surgical Prep
- Wound Care
- Front/Back Office
- Scheduling
Keyapplicableskills
- Operates with a high degree of sensitivity and confidentiality.
- Self-starter with strong problem-solving skills, able to assess situations and identify solutions.
- Good written, verbal and interpersonal communication skills.
- Well-organized, able to prioritize and multi-task with a keen eye for detail.
- Works independently with minimal direction and supervision.
- Computer knowledgeable in Microsoft Word, Excel, PowerPoint, and Outlook.
- Accurate data entry skills with typing speed of 50-60 wpm.
Languages
Spanish
Professional
Timeline
Call Center Supervisor
Bio-Genetics Laboratory
01.2021 - Current
Coverage Consultant (Private Contractor)
Bayfront Hospital Baby Place
01.2020 - 01.2021
Patient Advocate
CareValent
01.2018 - 01.2020
Healthcare Scheduler Specialist
Metro Health and Wellness
01.2017 - 01.2018
Care Coordinator
Cordant Health Solutions
01.2015 - 01.2016
Credentialing Specialist/Delegation
WellCare
01.2005 - 01.2010
Managed Care/Customer Service
Florida Orthopeadic Institute
01.2001 - 01.2005
Customer Service
Health Plan Services
01.1999 - 01.2001
Basic X-Ray Technician - Medical Office Procedures
Ultimate Medical Academy
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