Summary
Overview
Work History
Education
Skills
Timeline
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Wendy Govan

Oakland,CA

Summary

Dynamic Appeals and Grievances Coordinator at Altais with a proven track record in dispute resolution and exceptional communication skills. Enhanced member experiences through proactive problem-solving and effective teamwork, achieving expedited resolution times. Committed to quality improvement initiatives, fostering collaboration, and ensuring compliance with regulatory standards in healthcare services.

Healthcare professional with specialized expertise in handling appeals and grievances. Proven track record of resolving complex cases efficiently and positively impacting client satisfaction. Known for collaborative approach, adaptability, and strong problem-solving abilities, key to driving successful outcomes. Professional with solid background in appeals and grievances management. Adept at navigating complex regulatory frameworks and resolving issues efficiently. Strong focus on team collaboration, adaptability, and achieving results. Skilled in communication, conflict resolution, and policy interpretation, bringing reliability and flexibility to meet changing needs. Experienced with overseeing appeals and grievances processes to ensure timely resolutions. Utilizes strong analytical skills to evaluate case details and implement effective solutions. Knowledge of regulatory requirements and exceptional communication skills to foster positive client relationships. Equipped with strong problem-solving abilities, willingness to learn, and excellent communication skills. Poised to contribute to team success and achieve positive results. Ready to tackle new challenges and advance organizational objectives with dedication and enthusiasm. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Results-oriented achiever with proven ability to exceed targets and drive success in fast-paced environments. Combines strategic thinking with hands-on experience to deliver impactful solutions and enhance organizational performance.

Overview

25
25
years of professional experience

Work History

Appeals and Grievances Coordinator

Altais
11.2019 - Current
  • Processed and finalized appeals and grievances within agreed-upon turnaround time.
  • Remained knowledgeable regarding company policies and procedures and current developments within operational departments.
  • Submitted verbal and written notification to members and providers.
  • Served as a key resource for colleagues seeking guidance on case-specific issues or regulatory requirements, fostering a cooperative team environment.
  • Actively participated in quality improvement initiatives aimed at enhancing the overall member experience within the organization''s healthcare services offerings.
  • Expedited resolution times by proactively communicating with members, providers, and other stakeholders throughout the grievance process.
  • Provided exceptional customer service when interacting with individuals involved in each appeal or grievance situation, demonstrating empathy and professionalism at all times.
  • Managed approximately 30 incoming calls, emails and faxes per day from customers.'

Medical Assistant

UHC ALLIANCE
06.2016 - 10.2019
  • Sanitized, restocked, and organized exam rooms and medical equipment.
  • Obtained client medical history, medication information, symptoms, and allergies.
  • Directed patients to exam rooms, fielded questions, and prepared for physician examinations.
  • Performed medical records management, including filing, organizing and scanning documents.
  • Maintained a safe and clean clinical environment by adhering to infection control guidelines and disposing of biohazardous waste properly.
  • Facilitated seamless patient care with thorough and accurate documentation of medical histories, vital signs, and medications.
  • Assisted physicians with minor surgeries, including preparing operating room and sterilizing instruments.
  • Ensured patient safety and comfort during examinations, effectively addressing concerns and answering questions.
  • Kept medical supplies in sufficient stock by monitoring levels and submitting replenishment orders before depleted.
  • Boosted patient satisfaction by providing compassionate care and promptly addressing needs during visits.
  • Coordinated patient referrals to specialists or other healthcare providers as needed for comprehensive care management plans.
  • Streamlined office operations by managing inventory levels, ordering supplies, and organizing storage areas.
  • Supported patient well-being, providing empathetic care and addressing concerns with sensitivity.
  • Performed EKGs and other diagnostic tests, contributing to accurate and timely diagnoses.
  • Streamlined patient check-in process, reducing administrative burden for medical staff.
  • Facilitated positive patient experience, greeting patients warmly and providing clear directions within clinic.
  • Built strong relationships with patients through effective communication skills that foster trust in the clinic''s commitment to quality care.
  • Contributed to positive health outcomes by educating patients on preventative measures, treatment plans, and follow-up care instructions.
  • Aided in accurate diagnoses by performing laboratory tests and preparing specimens for analysis.

Medical Assistant- FLOAT POOL

Stanford Hospital
06.2000 - 05.2016
  • Built strong relationships with patients through effective communication skills that foster trust in the clinic''s commitment to quality care.
  • Enhanced clinic efficiency by assisting physicians with routine procedures and diagnostic tests.
  • Maintained strict adherence to infection control protocols by following proper sterilization techniques for medical equipment.
  • Improved patient experiences by efficiently managing appointments and maintaining organized medical records.
  • Contributed to positive health outcomes by educating patients on preventative measures, treatment plans, and follow-up care instructions.
  • Aided in accurate diagnoses by performing laboratory tests and preparing specimens for analysis.
  • Assisted in the development of clinic policies and procedures to ensure compliance with industry standards and regulations.
  • Provided support during emergencies by administering first aid treatments under physician supervision until further assistance arrived.
  • Contributed to clean and safe clinic environment by adhering to sanitation protocols.
  • Facilitated patient education on treatment plans and medications, improving understanding and compliance.
  • Conducted routine laboratory tests to assist in diagnosis and treatment of conditions.
  • Conducted patient follow-up calls to monitor treatment progress and answer any questions.
  • Answered telephone calls to offer office information, answer questions, and direct calls to staff.
  • Completed EKGs and other tests based on patient presentation in office.
  • Prepared lab specimens for diagnostic evaluation.
  • Explained procedures to patients to reduce anxieties and increase patient cooperation.
  • Taught patients about medications, procedures, and care plan instructions.
  • Assisted with routine checks and diagnostic testing by collecting and processing specimens.
  • Updated inventory, expiration and vaccine logs to maintain current tracking documentation.
  • Measured patient pulse oximetry.
  • Measured patient spirometry.
  • Sanitized, restocked, and organized exam rooms and medical equipment.
  • Obtained client medical history, medication information, symptoms, and allergies.
  • Directed patients to exam rooms, fielded questions, and prepared for physician examinations.
  • Performed medical records management, including filing, organizing and scanning documents.
  • Assisted physicians with minor surgeries, including preparing operating room and sterilizing instruments.
  • Kept medical supplies in sufficient stock by monitoring levels and submitting replenishment orders before depleted.
  • Boosted patient satisfaction by providing compassionate care and promptly addressing needs during visits.
  • Maintained a safe and clean clinical environment by adhering to infection control guidelines and disposing of biohazardous waste properly.
  • Ensured patient safety and comfort during examinations, effectively addressing concerns and answering questions.
  • Improved patient satisfaction, efficiently managing appointment schedules and reducing wait times.
  • Performed EKGs and other diagnostic tests, contributing to accurate and timely diagnoses.
  • Enhanced patient care by meticulously recording vital signs and updating patient records.
  • Assisted in minor surgical procedures, ensuring sterile environment and patient comfort.
  • Contributed to reduction in patient readmission rates by providing thorough discharge instructions and follow-up care recommendations.
  • Maintained inventory of medical supplies, ensuring availability for all procedures and treatments.
  • Administered medications and injections as prescribed, adhering strictly to protocols for patient safety.
  • Supported patient well-being, providing empathetic care and addressing concerns with sensitivity.
  • Streamlined patient check-in process, reducing administrative burden for medical staff.
  • Obtained and documented patient medical history, vital signs and current complaints at intake.
  • Collected and documented patient medical information such as blood pressure and weight.
  • Supported duties for diagnostic and technical treatment procedures, such as setting up and operating special medical equipment and apparatus.

Education

Certificate - MEDICAL ASSISTANT

Merritt College
Oakland, CA
06-2010

Certificate - EMT

Merritt College
Oakland, CA
01-1997

Skills

  • Dispute resolution
  • Assertiveness
  • Teamwork
  • Problem-solving
  • Time management
  • Multitasking skills
  • Attention to detail
  • Listening skills
  • Problem-solving abilities
  • Reliability
  • Excellent communication
  • Critical thinking
  • Organizational skills
  • Decision-making
  • Task prioritization
  • Self motivation
  • Analytical thinking
  • Conflict resolution
  • Complaint handling
  • Grievance handling
  • Multitasking

Timeline

Appeals and Grievances Coordinator

Altais
11.2019 - Current

Medical Assistant

UHC ALLIANCE
06.2016 - 10.2019

Medical Assistant- FLOAT POOL

Stanford Hospital
06.2000 - 05.2016

Certificate - MEDICAL ASSISTANT

Merritt College

Certificate - EMT

Merritt College

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