Customer Service Health Insurance
Resume:
Gerald Edward Guillen
Austin, Texas 78758
aczbwx@r.postjobfree.com
Experience:
HNI Medical Services November 2015-Presently Working
Senior Payer Enrollment Specialist
7500 Rialto Blvd, STE 1-140
Austin, Texas 78735-8534
Ellen Andrew –Supervisor 512-***-****
aczbwx@r.postjobfree.com
* Assisted in obtaining hospital privileges for Providers and mid-levels.
* I was responsible for the accuracy and consistent preparation of applications and supporting documents for enrolling physicians, and Mid-levels into CMS/Medicare, Medicaid, Blue Cross Blue Shield, and Rail Road Medicare for the states of Texas, Florida, Louisiana and Rhode Island, and California.
* Responsible for monitoring enrollment progress at the payer to ensure timely processing, minimize developments, rejections, lost applications and any other delay at the payer that may cause loss of revenue due to timely filing.
* Built knowledge base for payer requirements and forms.
* Developed a working knowledge of payer policies for multiple states
* Established a strong working relationship with team members in the Physician Services Department for issues on new hires, missing credentials and outstanding enrollment applications.
* Daily work with Excel spreadsheets in managing providers, new groups and payers.
Accenture (Temp.Job) November 2014- October 2015
Provider Enrollment Specialist
12365 Riata Trace Parkway
Austin, Texas 78727
512-***-**** Naomi Gaytan-Supervisor
aczbwx@r.postjobfree.com
* Interact professionally with providers and ancillary staff to provide appropriate and timely response to inquiries and concerns regarding provider enrollment and file maintenance for Medicaid programs (including dental, vision, ambulance, physicians, nurses and all other provider types).
* Provided outreach and assistance in completing electronic enrollment applications unacceptable to the Texas Medicaid system.
* Data entry (of paper applications) with validation of provider submitted enrollment information to insure the enrollment application meets the minimum standards.
* Composed and sent deficiency letters to notify providers of incomplete/inaccurate applications; revising existing deficiencies and sending corrected letters based on QA audits as required.
* Adhered to Quality Assurance program in order to improve daily processing of applications and file maintenance transactions with a minimum quality score of 98%.
* Made recommendations to management to improve efficiency/effectiveness of current manual processes through systemic modifications.
* Responded to Tier III escalations and/or file maintenance requests as assigned within the specified due dates.
Maximus 2013 - 2014
Bilingual Eligibility and Enrollment Specialist
4335 Paredes Line Rd.
Brownsville, Texas 78526
956-***-**** / Emmanuel Avila - Supervisor
* Reviewed applications and other financial and immigration documents for Market Place Health Insurance eligibility and enrollment for the Affordable Care Act “Obamacare”, and for Medicaid, CHIP and Women's Health Insurance Program when not eligible for Marketplace coverage
* Collected, analyzed, evaluated, and verified financial and immigration documents submitted by consumers by using government and state databases for eligibility of tax credits and other state programs such as Medicaid, CHIP, and Women’s Health Insurance for assistance.
*Pivotal in providing proper feedback and solutions to mainstream the Affordable
Care Act Ramp Up program and resolved escalated issues from consumers.
* Excellent Bilingual customer service skills and data entry skills.
*Excellent oral, written and computer skills-EXCEL, Word, Power Point, Access, Maxstar.
*Educated and assisted the public in community outreach events, public health fairs, and faith based events throughout several counties in south Texas on the Affordable Care Act and enrollment.
Texas 211/ Unitedway 2009 -2012
Eligibility/Information and Referral Specialist
2000 E. MLK Jr.
Austin, Texas 78702
512-***-**** La Tessa Nora-Manager / Mr. Art Cosme-Human Resources
* Conducted reviews to determine or verify eligibility or continued eligibility and benefit level for the Travis County Indigent Health Plan.
* Processed changes to client status, over payments, and adjusted or restored benefits.
* Interviewed clients or authorized representative to gather information to determine eligibility for benefits.
* Provided bilingual customer service and advocacy, such as limited instructions on proceeding
with claims or referrals to other local, state and government agencies.
*Updated the local Special Needs Registry through calls to local residents; verified information
provided by Texas 2-1-1, provided necessary instructions to local residents needing evacuation
information.
*Organized and worked with detailed HHSC, Medicaid,CHIP,Womens Health Insurance Program, Texas Health Steps and other state records using computers (MAXSTAR, AMISYS, Excel, Word,) to enter, access, search and retrieve data.
University of Texas at Brownsville 2006 to 2008
Financial Aid Senior Mentor/Outreach
80 Fort Brown
Brownsville, Texas 78520
956-***-**** Gina Salinas / Mari Chapa FA Director
aczbwx@r.postjobfree.com
*Prepared and reviewed reports and data for internal and external reporting and perform statistical analysis.
*Reconciled financial aid program accounts with the financial aid accounting office.
*Provided information to students regarding financial aid programs, application procedures,
award packaging.
*Reviewed applications and other documents for student financial aid eligibility per the
Department of Education eligibility requirements.
*Participated in preparing for and facilitating financial aid workshops and presentations.
*Assisted students, prospective students and others regarding eligibility requirements of financial aid.
*Experienced in the use of a variety of computer applications and reporting tools including, but
not limited to, Datatel, Microsoft Access and Excel.
*Proficient in using e-mail, word processing, spreadsheet, database, and presentation software
and use of the Internet to access data, maintain records, generate reports, and communicate with
others.
*Excellent Bilingual customer service skills and interpersonal skills.
Rivera Chiropractic Clinics 2003- 2006
Chiropractic Assistant/ Assistant Office Manager
814 E Harrison Ave.
Harlingen, Texas 78550
956-***-**** Dr. Jaime Rivera - Owner/Doctor
aczbwx@r.postjobfree.com
* Efficiently worked front desk: insurance verification, patient intake,
balanced daily reports, made daily deposits, set patient appointments,
*Experienced in the use of a variety of computer applications and reporting tools including, but
not limited to, Datatel, Microsoft Access and Excel.
*Proficient in using e-mail, word processing, spreadsheet, database, and presentation software
and use of the Internet to access data, maintain records, generate reports, and communicate with
others.
*Excellent Bilingual customer service skills and interpersonal skills.
Rivera Chiropractic Clinics 2003- 2006
Chiropractic Assistant/ Assistant Office Manager
814 E Harrison Ave.
Harlingen, Texas 78550
956-***-**** Dr. Jaime Rivera - Owner/Doctor
aczbwx@r.postjobfree.com
* Efficiently worked front desk: insurance verification, patient intake,
balanced daily reports, made daily deposits, set patient appointments,
answered phones.
* Properly billed and posted payments on all Major Medical, Texas
Workers Compensation, Medicare Insurance and patient co-payments and deductibles.
* Protected the security of medical records to ensure that confidentiality
(HIPPA) is maintained.
* Took vitals, ranges of motion, administered therapies such as ultra sound,
laser, electric stimulation, kinetic exercises and conducted Functional
Capacity Evaluation testing and reports on patients.
United States Navy-USS Orion As-18
Mess Management Specialist
La Magdalena, Italy
Norfolk Naval Base-decommissioned ship
* Read and interprets documents (OSHA) such as safety rules, operating and maintenance instructions, procedure manuals, and service orders.
* Able to speak effectively with groups of customers or employees of organization
* Verified and kept records on incoming and outgoing shipments and prepared items for
shipment.
* Compared identifying information and counts, weights, or measured items of incoming and
outgoing shipments to verify information against bills of lading, invoices, orders, or other records.
EDUCATION:
University of Texas at Brownsville
Bachelors Degree-Multi Disciplinary Studies-Business Administration/Allied Health
December 2013
Associates Degree May 2008
Fluency in Spanish -read, write, and speak
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