Data Analyst Clinical Research
Resume:
Carla Gomez (Hannibal)
**************@*****.***
www.linkedin./carlahannibal
https://bold.pro/my/carla-gomez-240*********
Professional Summary
Versatile Administrative professional well-verse in healthcare practices, compliance standards and operations. Excellent problem-solver and clear communicator with positive and upbeat personality. Goal-oriented and welcoming with proven history of modernizing traditional offices to maximize patient satisfaction. Natural leader experienced in driving effective team success by coaching and motivating team members to increase financial profitability, operational efficiency, and client satisfaction. Record of performance in meeting organizational objectives. Excellent interpersonal skills, ability to work well with others, in both supervisory and support staff roles.
Skills /Knowledge
Microsoft 365-Database-Surveys
Medical Manager- Practice Administrator
Certificate Clinical Research Studies
Computer Accounting
B2B, Negotiations
Market Research-Planning and Development
Case Documentation
Data Entry-CMS Billing-Coding
Regulatory Compliance –Contract Negotiations and Review
Medicaid Regulations
Multidisciplinary Team Collaboration
Accounts Receivable/Payable -Payment Collections
Health Insurance (BC/BS, Humana, UnitedHealth., -Insurance Verification
Policy and Program Development
Basic Patient Assistant- Appointment Scheduling
Work History
Contract Analyst-10-2023 -4-2024
TEKsystems-Albuquerque, NM
Registration of Medicaid Client/ Data Analyst
Processing New/Renewable and various Medicaid Categories
Patient Relations Liaison, 02/2008 to 04/2010
North Scottsdale Family Medicine – Scottsdale, AZ
Assisted patients in filling out check-in and payment paperwork.
Took copayments and compiled daily financial records.
Routinely collaborated with department managers to correct problems and improve services.
Assisted in resolving and satisfying client requests and internal operational issues.
Facilitated timely check-in by greeting visitors and establishing purpose of visits.
Investigated, provided and submitted information to Quality Department about special incidents, events and complaints.
CEO, 12/2007 to 04/2009
Hannibal Professional Services, LLC – Peoria, AZ
Design and deliver training modules for accreditation URAC.
Billing on a contract basis for Physicians and RTC
Credentialing and Contract Negotiations for Clients
Develop legal and regulatory compliance programs.
Design custom practice management manuals.
Design marketing campaigns for clients.
Research and write articles based on industry trends to inform clients.
Develop and maintain corporate relationships.
Utilize social media avenues to increase business contacts.
Maximize B2B networking potential.
Oversaw daily administrative operations.
Practice Administrator, 04/2007 to 02/2008
Cactus Psychiatric Associates – Scottsdale, AZ
Developed and established policies, procedures and objectives
Ensured adequate execution, of compliance issues, and updates.
Evaluated general and specific business conditions as they related to operational issues and advised the physicians on these matters, then developed organizational objectives, and plans for their achievement.
Implemented sales of pharmaceuticals to increase revenue for practice.
Increased revenue by 30% by identifying charges not previously captured and lowered A/R balance.
Within scope of authority, ensured the development of systems (both manual and automated) to properly support practice-wide activities based upon the needs of the practice.
Developed and executed organizational procedures and controls to promote communication and adequate information flow within the practice.
Monitored, analyzed, assessed, and communicated practice progress during weekly meetings.
Ensured compliance and adherence to the organization's structure, management philosophy, and mission statements.
Developed strategic and operational plans; managed the financial performance, coordinated physicians' contracts with specific payors and supervised front desk and billing staff.
Managed day-to-day financial activities, including posting insurance payments, A/R, A/P, Payroll, quarterly taxes, EOM reports, banking, all H/R issues, and credentialing.
Client Relations and Clinical Staff Development Administrator, 02/2003 to 04/2007
Physicians' Review Network – Phoenix, AZ
Actively involved in all phases of the Utilization Review process
Oversight for hiring, training case coordinators and support services personnel.
Supervised both Clinical/, Managed day-to-day department activities: establishing priorities, monitoring supervisors, troubleshooting.
Maintained and updated client information on the company database
Motivated staff by providing environment conducive to open communication and opportunities for professional development.
Assisted in the development of new policies and procedures.
Monitored Legal, Regulatory and Compliance issues with company attorney.
Launched Phy-Rev University Training Module and established the program procedures and guidelines for URAC accreditation.
Assisted with planning and management of performance improvement initiatives in the organization.
Welcomed constructive criticism from clients, case managers and physicians and employees for system improvements.
Performed market research surveys amongst client base to seek feedback on customer service, follow-up methods and quality of completed reports.
Improved customer service, based on client feedback through the development of new policies and procedures.
Successfully handled all client related issues.
Worked with IT department, Report Integrity and Quality Assurance Departments on departmental issues and feasible solutions for implementation and resolution.
Worked with Medical and Associate Medical Directors for better case management processing.
Conducted research study on quality of services for URAC accreditation.
Created and implemented new training program for URAC accreditation.
Member of Credentialing Committee, Quality Assurance Committee and IT committee and Chairwoman of Staff Development and Education Committee
Developed, implemented and revised policies and procedures required to ensure compliance to URAC requirements.
Audited compliance regulations to standards on a quarterly basis and implemented appropriate interventions to achieve departmental goals.
Prepared case files for physicians' review or medical director, this included preparation of clinical information and correspondence.
Office Manager, 12/2000 to 02/2003
Thunderbird Rd Chiropractic – Glendale, AZ
Maintained records management systems, billing, coding, A/R and basic bookkeeping work.
Registered /Scheduled patient appointments for physicians.
Demonstrated ability to maintain composure and work efficiently, preserving patient confidentiality.
Performed drug/alcohol testing for potential employees of AZ DOT, and other contracted employers.
Maintained and purchased office supplies and equipment.
Posted payments to correct accounts using correct contractual allowance according to specific insurance contract.
Prepared refunds for patient records and insurance companies for overpayments
Explained to patients, charges, services and practice policies regarding payment of bills.
Set up payment arrangements and monitored accounts per policy and procedures using special reports.
Handled all incoming mail related to insurance companies in a timely manner and responded to patient requests.
Performed various clerical duties to expedite the collection process, including medical record requests and patient information.
Obtained authorization and ensured eligibility.
Administrative Assistant, 04/1999 to 12/2000
Physiotherapy Associates, Inc – Memphis, TN
Provided administrative support to the Administrator and Associate Chief of Physical Therapy
Scheduled and greeted patients, increased productivity through superior patient interaction allowing more staff to evaluate more patients.
Decreased A/R
Maintained new referral tracking system for improved patient care to prevent delays in patient treatment.
Handled all incoming mail related to insurance companies in a timely manner and responded to patient requests.
Performed various clerical duties to expedite the collection process, including medical record requests and patient information.
Performed written and/or verbal inquiries to various payers to reconcile patient accounts.
Obtained authorization and ensured eligibility of patient insurance coverage.
Education
Gateway Community College
Clinical Research--Certificate of Completion
Nursing Assistant --Certificate of Completion
University of Phoenix - Phoenix, AZ
Human Services ND
Capps College - Mobile, AL
Phlebotomy_ Certificate of Completion
University of South Alabama-Mobile Al
Huffstetler Business College - Mobile, AL
Associate of Applied Science: Computer Accounting
Dean's List 1984,1985
Coursework in Computer Accounting
Graduated in Top 3% of Class
Certifications
Certified Medical Manager (CMM) Certified Practice Manager (CPM) Certified Internet Marketing Business Specialist (CIMBS) Arizona Notary Public CPR/AED Certificate Publications
Affiliations
PAHCOM (Professional Association of Healthcare Office Management) POMAA (President) Physician Office Managers Association of America American Association of Notaries E-Book Developers Association
Accomplishments
Achieved certification through the Institute of Certified Professional Managers (ICPM): Certified Manager (CM)
Technology Proficient
Developed a strong knowledge of hardware and software while keeping abreast of new applications that increased efficiency and productivity for management and clients.
Training
Trained medical billing staff on employees on the office policies and 3rd party insurance, Medicare, Medicaid, HMO and PPO billing procedures.
Managed inventory and office budgeting for supplies for busy office
Billing
Cooperated with Medicare, Medicaid and private insurance providers to establish relationships and resolve billing issues.
Held first-point-of-contact for all internal and external communications with executive-level officers.
Successfully resolved patient issues
Streamlined workflow by consolidating lengthy processes and redundant documentation that resulted in more effective and timely completion of financial reports.
Increased company revenue per month in by 40%
Additional Information
Publications:
Contributions:
"Put a positive spin on what is said in the office", The Doctor's Office, HealthLeadersMedia (a division of HCPro),
May 2008, Vol. 27 No. 5.
"Best practices for putting yourself out there", The Doctor's Office, HealthLeaders Media (a division of HCPro),
December 2008, Vol. 27 No.12.
"Keeping the peace among your practice employees", The Doctor's Office, HealthLeaders Media (a division off HCPro,
September 2008, Vol. 27 No.9
Published Articles:
"New Beginnings", POMAA News, POMAA (Physician’s Office Managers Association of America)
September/October 2008, Vol. 1 No. 1
"Health in the Workplace", POMAA News, POMAA (Physician’s Office Managers Association of America)
November/December 2008, Vol 1 No. 2
"Do Not Take Care of the Elderly", POMAA News, POMAA (Physician’s Office Managers Association of America)
January/February 2008, Vol. 2 No. 1
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