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Customer Service Medical

Miami, Florida, United States
April 10, 2018

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Maivelis Gonzalez

Phone: 786-***-**** E-mail:

Professional Summary

Organized Call Center Manager with clinical/administrative and Durable Medical Equipment experience leading tasks in a fast-paced work environment with time efficiency. Exceptional interpersonal skills with work-flow prioritization. Specialize in health information technology and maintaining patient files in accordance with state and federal requirements. Extensive knowledge of managed care Medicare and Medicaid State and Federal guidelines.

Core Qualifications

•Excellent clerical and leading skills

•Medical record management

•Medical terminology knowledge

•Detail-oriented & Excellent customer service skills

•Superior written and verbal communication

•Time management

•Strong mentoring and relationship building skills

•ICD 10 knowledge

•Knowledge of Transplant and facilities

•Flmmis knowledge


Prestige Health Choice, Inc. May 2017 March 2018

Non-Clinical Reviewer/Transplant Coordinator (department outsourced)

Conduct Review and approvals of DME referrals

Review nutrition request for determination of services.

Coordinate, generate and track both incoming and outgoing correspondence, faxes and authorizations related to prospective, concurrent and post service review functions.

Conduct reviews and approvals for Transplant members and assist with scheduling procedures

Interacts with facilities, vendors, providers, and other staff to facilitate receipt of information, and /or records for prompt review and response.

Enter UM authorizations and pre-payment review requests in UM platform using ICD-10 and HCPCS codes.

Contact requesting providers to obtain medical records or other necessary documentation related to specific UM request, meet internal and regulator deadlines for UM cases.

Complete tasks assigned by UM Nurses and document as required.

Other duties as assigned by UM Director.

MCCI, Inc. July 2016 – March 2017

Call Center Manager

•Daily call monitoring and documentation for 15 call agents

•Created a call center team that works well together by organizing practice activities to maximize employee productivity and ensuring that day-to-day call center activities and work-flow runs smoothly

•Ensure that telephone calls and online portal questions are answered promptly and professionally

•Plan, develop and support or conduct orientations, training programs and create educational material for staff members to improve skills, aid in professional growth and development

•Implement initiatives and strategies to ensure Miami Dade and Broward centers are providing excellent customer service to patients

•Maintain, monitor and generate call center reports

•Responsible for all interviewing and hiring, terminations, performance/salary reviews and disciplinary actions

•Resolve problems to insure compliance and customer satisfaction

•Collect and analyze call-center statistics and metrics

•Conduct monthly meetings with compliance and marketing team in order to develop new strategies to increase member enrollment

•Institute call center and all center projects for all branches (Miami Dade, Broward and Jacksonville) and analyze center needs and implement recommendations

United Health Group/Preferred Care Partners Miami, Florida June 2011 – June 2016

Case/Disease Management Clinical Administrative Assistant

•Managed all clerical tasks in department including answering phones processing mail preparing summaries and directing information workflow.

•Coordinated department inventory by requisitioning receiving tracking and maintaining supplies.

•Maintained knowledge of all current requirements governing confidentiality and use of electronic medical records for department.

•Participated in Utilization, Case Management and Clinical Performance team ultimately helping to direct the improvement of more than 30 processes.

•Organize and coordinate travel arrangements for the department director and Medical Directors including air, hotel and transportation

•Verify and update patient demographics for department Case Managers, Social Workers, and Transplant nurse coordinator

•Coordinate new hire on boarding and schedule interviews

•Collaborate with the leadership team and other contacts to gather data, prepare reports, and presentations for meetings, trainings and special events

•Coordinates departmental meetings and other committees including taking minutes, prepare agendas, and send out communication

•Utilize data from database to create spreadsheets, mailing lists, educational materials and correspondence

•Distribute daily census while maintaining admissions, transplant and current transplant waiting list records

•AHCA, CMS, URAQ, NCQA accreditations coordination and oversight support

•Peer to Peer coordination and Utilization Management

Sheridan Medical Center January 2009 - June 2011

Front Office Team Lead

•Verified insurance coverage and collected co-payments

•Sorted and distributed lab results and other paperwork

•Maintained and updated more than 7000 patient files

•Process weekly reports on patient visit types and other relevant data

•Facilitated daily administrative functions, including customer service, patient scheduling, and inventory management

•Oversee payroll for department employees and conduct interviews for new personnel

•Oversee and coordinate the order of supplies

•Coordinate staff coverage for vacancies due to vacation or leave time of employees

•Maintain confidentiality of all information concerning patients

•Ensure all employees follow company policies and procedures

•Create, Implement and Monitor new processes when required

•Update and maintain assigned training manuals

•Monitor tasks and workflow to ensure office priorities and goals are met

•Manage team performance

•Resolve customer service and operational problems


High School

February 2006 American Christian Academy Miami, Florida

References furnished upon request

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