Summary
Overview
Work History
Education
Skills
Coremedicalproficiencies
Keyapplicableskills
Languages
Timeline
Generic

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, FL
01.2011

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
Tanya Gomez