Georgina Reynolds
Chula Vista,CA
Summary
Detail-oriented Healthcare Operations and Medical Administrative Professional with 4 years of experience in Medicare operations, referral coordination, and insurance authorization. Currently serving as Representative II, Operations, responsible for processing Medicare Part D requests and ensuring compliance with CMS regulations. Expertise in case management, provider communication, EHR systems, and HIPAA compliance. Bilingual in English and Spanish.
Overview
6
6
years of professional experience
Work History
Representative II, Op. (Crossed-Trained in Rep I-Intake)
CVS Health (Contract through Aline Staffing)
San Diego, CA
11.2025 - Current
- Processed Medicare Part D pharmacy benefit requests while adhering to CMS guidelines and company policies. Reviewed member cases to analyze documentation and collaborated with healthcare providers to gather additional clinical information. Maintained accurate case documentation while using multiple software systems to support timely case processing and deliver excellent service to members and providers. Cross-trained in both Rep. II operations and Rep. I intake responsibilities, demonstrating the ability to assist with various workflows in a fast-paced healthcare environment while meeting productivity and quality expectations.
Authorizations/ Referral Coordinator
Digestive Disease Associates
San Diego
05.2021 - 10.2021
- Educated patients on healthcare policies, insurance coverage, and available treatment options to enhance understanding and satisfaction. Processed and managed patient authorizations and referrals to ensure timely access to medical services and specialists. Handled and collaborated 6-10 authorizations or referrals per hours with healthcare providers and insurance companies to obtain necessary approvals and resolve any discrepancies. .
Call Center Representative
Digestive Disease Associates
San Diego
10.2020 - 05.2021
- Provided exceptional customer service by responding to patient inquiries regarding medical services, billing, and appointment scheduling. Successfully managed a high-volume call queue of 15–25 calls per hour while prioritizing multiple patient needs, handling multiple calls simultaneously. Accurately documented patient information in electronic health record (EHR) systems and ensured compliance with HIPAA and privacy regulations. Assessed the urgency of patient concerns and routed critical calls to the appropriate medical staff for prompt attention.
Education
Medical Office Specialist Certificate -
UEI College Chula Vista
Chula Vista, CA07-2019
High School Diploma - undefined
Montgomery Adult School
Chula Vista07-2011
Skills
- Electronic Health Records (EHR)
- Insurance Verification (HMO, PPO, Medicare & Medicaid)
- Prior Authorizations & Referrals
- Case Review & Documentation
- HIPAA & OSHA Compliance
- Medicare Part D
- CMS Guidelines
- CPT & ICD-10
- Medical Terminology
- Data entry proficiency
- Multi-System Navigation
- Microsoft Office Suite
- Windows-Based Operations
- AS400, MHK, People Safe, The Source
- Medical Office
- Caring with Heart
Mentor
- September 2019 – March 2020
- A Leadership program that connects people who have specific skills and knowledge (mentors) with individuals who need or want the same skills and advantages to move up in work, skill level, or school performance
Timeline
Representative II, Op. (Crossed-Trained in Rep I-Intake)
CVS Health (Contract through Aline Staffing)
11.2025 - Current
Authorizations/ Referral Coordinator
Digestive Disease Associates
05.2021 - 10.2021
Call Center Representative
Digestive Disease Associates
10.2020 - 05.2021
High School Diploma - undefined
Montgomery Adult School
Medical Office Specialist Certificate -
UEI College Chula Vista