CAROLYN WILLIAMS
Antelope
Summary
Seasoned professional with a robust background in healthcare and customer service, notably at Delta Dental. Excelled in enhancing patient and customer experiences through expert healthcare administration knowledge and exceptional active listening skills. Achieved significant improvements in customer satisfaction and operational efficiency. Renowned for building strong relationships and resolving complex issues swiftly.
Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Committed to leveraging these qualities to drive team success and contribute to organizational growth.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Dental Paraprofesional
Arthur Lawrence
07.2024 - 09.2024
- Review and approve treatment authorization request (TAR) claim lines that meet policy requirements
- Confirm TAR and/or claim documentation is complete and complies with policy
- Send resubmission turnaround documents (RTDs) to dental providers to correct mistakes or gather missing information from submitted TAR and claims
- Communicate and collaborate with dental consultants toward the goal of final adjudication
- Evaluate dental claims, adjustments, and prior authorization requests against Medi-Cal Dental criteria
- Generate requests to dental providers for missing claims information
- Confirm that claims documentation is complete, complies with policy, and refer documents to dental professionals when required.
Customer Service Representative
Oasis Marketing Solutions
06.2012 - 09.2024
- Built long-term customer relationships and advised customers on purchases and promotions
- Described product to customers and accurately explained details and care of merchandise
- Documented all customer inquiries and comments thoroughly and quickly
- Responded to all customer inquiries thoroughly and professionally
- Greeted customers in a timely fashion, while quickly determining their needs
- Handled customer complaints and inquiries in a courteous and efficient manner
- Developed strong customer relationships and loyalty through effective communication
- Maintained knowledge of company products to provide helpful suggestions and recommendations to customers
- Provided excellent customer service to resolve customer complaints in a timely manner.
Provider Concierge Specialist
Delta Dental
08.2021 - 08.2023
- Responded to provider calls and correspondence related to instructions on network participation, contract interpretation, contracted fees, resolving complex claims and service issues, provider communications and provider terminations at the point of contact
- Educated and promotes the various Delta provider networks; drafted content for various collateral materials for distribution to network dentists; advises local Delta Dental member company PR staff on program changes, and quickly identifies trends in service issues and recommends courses of action
- Builds and maintains strong relationships with the local Delta Dental member companies to achieve common goals; works to meet the local business needs and the Federal Services needs for recruitment and contracting of the PPO network, as needed to support the Network Development business unit.
Mental Health Technician/Care Coordinator
Supplemental Healthcare
03.2011 - 01.2019
- Participated in weekly multidisciplinary team meetings to discuss patient progress and plan further interventions
- Collaborated with other healthcare professionals such as social workers, psychiatrists, counselors and nurses to coordinate quality care for each client
- Created activities that promoted physical wellness, emotional stability, cognitive functioning, independent living skills and social interaction among patients
- Ensured safety of all clients through continuous observation and monitoring during shift hours
- Encouraged positive behaviors through rewards systems when appropriate
- Assisted in transporting clients to appointments outside the facility when necessary
- Supported clients in developing daily living skills such as budgeting money or time management.
- Helped patients with meals, activities of daily living (ADLs) and facility transfers to promote security and patient well-being.
- Performed scheduled patient safety checks and documented results to establish patients' well-being.
- Used company software and databases to maintain records of services performed and patient conditions.
- Managed patient caseloads effectively, ensuring timely follow-up and appropriate interventions.
- Developed strong relationships with community partners, facilitating referrals and collaboration on behalf of patients.
- Provided crisis intervention and de-escalation techniques for patients experiencing emotional distress or exhibiting aggressive behaviors.
Medical Assistant/Mental Health Worker
Medical Staffing Network Acute Healthcare
06.2006 - 05.2011
- Observe and document patient's behavioral in accordance with internal and external health standards
- Provide one on one healthcare to suicidal and aggravated patients as directed
- Offered and documented treatment consent forms in patient health records
- Trained in substance abuse, co-occurring disorders, and the effect of employment and housing issues on mental health
- Observed and monitored client behavior and responses to treatment
- Connected clients with community service and resource agencies
- Documented psychiatric services and responses to treatment in patient case files
- Mediated conflicts within families to clarify and resolve underlying issues
- Used verbal and physical strategies to manage behaviors and uphold treatment plans.
Education
Medical Assistant Certificate -
Trinity College California
No Degree - Medical Social Work
Solano College California
Fairfield, CASkills
- Call center experience
- Healthcare Billing Procedures
- Healthcare Administration
- Healthcare coding
- Healthcare industry understanding
- Healthcare Software Proficiency
- Preventive healthcare strategies
- Active Listening
- Dental records
- Patient Needs Assessment
- Behavior management
- Effective communication
- Small group and individual assistance
- Helping students with special needs
Certification
- Microsoft Excel Knowledge
- Microsoft Office proficiency
- Medical Assistant Certified
- CPR and First Aid Certification
Timeline
Dental Paraprofesional
Arthur Lawrence
07.2024 - 09.2024
Provider Concierge Specialist
Delta Dental
08.2021 - 08.2023
Customer Service Representative
Oasis Marketing Solutions
06.2012 - 09.2024
Mental Health Technician/Care Coordinator
Supplemental Healthcare
03.2011 - 01.2019
Medical Assistant/Mental Health Worker
Medical Staffing Network Acute Healthcare
06.2006 - 05.2011
Medical Assistant Certificate -
Trinity College California
No Degree - Medical Social Work
Solano College California
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