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Service Representative Customer

Suitland-Silver Hill, Maryland, 20746, United States
February 01, 2018

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Sheri A. Gonzales

Temple Hills, Maryland ***** • • 301-***-****

Administrative Specialist

Talented Care Transition Specialist and administrative professional with over 20 years' experience providing strategic guidance and support in dynamic health settings.

Key Qualifications

• Proven ability to multi-task; able to handle multiple issues simultaneously ranging from patient administration to data interface and coordination for healthcare providers.

• Adept at problem-solving in fast-paced health environments to produce timely, accurate results critical in proper care management.

• Highly detail-oriented and focused with strong organizational skills; exceptional in supporting healthcare staff during high stress periods.

• Expertise in FEP Direct, ICentric, FLEXX, NASCO, Facets, Microsoft Office Suite (Word, Excel, PowerPoint, Access, Outlook), and Lotus Notes.

Professional Experience

American Health Associates – Columbia, Maryland

Client Service Representative, 2017 to present

Manages and resolves problems that arise regarding patient lab draws, reschedules and dispatches phlebotomist visits. Answers incoming calls about lab results and services and makes outbound calls to facilities to update them on patients with critical lab results. Provides accurate data entry of lab orders.

Selected Contributions:

• Dispatches phlebotomist for Stat services.

• Maintains record of all problems with services provided.

• Researches service orders

• Accurate data entry.

• Process incoming Lab Specimen.

CareFirst BlueCross/BlueShield – Washington, District of Columbia

Care Transition Specialist, 2008 to 2016

Facilitated inpatient stays, outpatient care, and ancillary services by creating and managing authorizations, verifying patient eligibility and benefits, and confirming Medicare and other party liability. Tasked with inputting and managing patient discharges and admissions. Lead administrative provider for nursing staff and supervisors. Provided mentoring and training for new staff members.

Selected Contributions:

• Trained and mentored new staff members.

• Interpreted and assessed patient eligibility and benefits to facilitate accurate services/treatments being delivered to patients.

• Orchestrated quality assurance of all authorizations ensuring accuracy in matching claims to authorizations for successful and timely processing.

CareFirst BlueCross/BlueShield – Washington, District of Columbia

Senior Associate Care Coordinator, 2005 to 2008

Directed and handled calls received through Automatic Call Distribution System (ACDS) while managing inquiries from Nurse Case Managers, Providers, Patients, and Internal Associates. Assigned cases, managed documentation in departmental intake logs, and entered data for assessment and implementation.

Selected Contributions:

• Interpreted patient eligibility, benefits, and demographic data to support Nurse Case Managers with accurate information for new cases.

• Expertly communicated authorizations, claims, benefits eligibility, and other insurance specifics to internal associates, providers, patients and out-of-state BCBS sites to coordinate effective care.

CareFirst BlueCross/BlueShield – Washington, District of Columbia

Member Service Representative/Away-From-Home Care Coordinator, 2002 to 2005

Directed and handled calls received through ACDS, Provided member and provider eligibility and benefits verification. Coordinator for instate and out-of-state travel including member enrollment.

Selected Contributions:

• Interfaced with online sites to verify BlueCross/BlueShield guidelines, covered service areas, and enrollment criteria by expertly interpreting operating manuals, certificates, and brochures.

• Effectively communicated interpreted data to Members, Providers, Brokers, and Administrators.

Educational Background

Certificate, Computer Operations

Yorktowne Business Institute, Landover, Maryland


Medical Terminology, Medical Coding, ISP/InterQual, Automatic Call Distribution System,

Lucent Call Master IV, Milliman and Roberts, Centre Vu 8.0

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