Summary
Overview
Work History
Education
Skills
Timeline
Generic

Dominique Rowell

Phenix City,AL

Summary

Dedicated and detail-oriented Healthcare Operations Support Specialist with a strong focus on repricing and customer service. Over 5 years of experience in healthcare operations, claims review, and customer support. Proven ability to enhance operational efficiency, reduce costs, and ensure compliance with healthcare regulations. Passionate about achieving new levels of excellence in the healthcare field.

Overview

7
7
years of professional experience

Work History

Senior Customer Service Representative

Optum
11.2021 - Current
  • Review claims and benefits on inbound calls.
  • Train new employees on call script use, Facets, SEER, Prior Authorization, documentation, and payments
  • Escalate issues to the proper departments.
  • Resolve providers' claim issues using company’s policies and processes.
  • Assist with responding to emails and live chat

Client Relationship Manager

TAS United
09.2020 - 11.2021
  • Address and resolve customer complaints and issues to improve satisfaction.
  • Evaluate staff performance and provide coaching to address inefficiencies.
  • Provide quality assurance on calls to reduce errors and improve process performance for clients.
  • Identify opportunities to cross or up-sell and communicate customer needs.
  • Exceeded annual revenue by 5% through improving client relationships and education.
  • Data Analysis & Reporting

Medical Case Specialist

QTC Medical Group
05.2019 - 09.2020
  • Reviewed medical records to arrange veteran’s exams.
  • Collected, arranged, and input information into database systems.
  • Generated reports detailing the physician findings and recommendations.
  • Created Excel spreadsheets to track clients' follow-up exams.
  • Coordinated traveling arrangements for Veterans.
  • Assisted with reimbursements for travel expenses.

Customer Service Representative

Superior Health Plan Inc
09.2017 - 04.2019
  • Reviewed medical records for Medicaid foster children.
  • Addressed providers' concerns about claims.
  • Created Excel spreadsheets and followed up on unpaid claims, insurance balance.
  • Created emails to providers requesting medical records when needed.
  • Complied with regulations and guidelines to process Medicaid claims.
  • Reviewed claims for fraud, waste, and abuse.


Education

Bachelor of Science - Criminal Justice

Columbus State University
Columbus, GA

Associate of Applied Science - Medical Assistant

Chattahoochee Valley Community College
Phenix City, AL
05-2025

Skills

  • Repricing Strategies
  • Healthcare Operations
  • Data Analysis & Reporting
  • Process Improvement
  • Compliance & Regulatory Adherence
  • Customer Service Excellence
  • Communication & Collaboration
  • Documentation Review
  • Escalation Management
  • Staff Training
  • Call Center Experience
  • Quality Assurance
  • Live Chat Support
  • Billing Elements Interpretation
  • ICD-10-CM/PCS, CPT-4, HCPCS Coding
  • Diagnostic Grouper Tools (DRG, APR-DRG, EAPG, APC)
  • Provider Contracts Payment Methodologies
  • Medicare/Medicaid Payment Rules

Timeline

Senior Customer Service Representative

Optum
11.2021 - Current

Client Relationship Manager

TAS United
09.2020 - 11.2021

Medical Case Specialist

QTC Medical Group
05.2019 - 09.2020

Customer Service Representative

Superior Health Plan Inc
09.2017 - 04.2019

Bachelor of Science - Criminal Justice

Columbus State University

Associate of Applied Science - Medical Assistant

Chattahoochee Valley Community College

Similar Profiles

CREATE PROFILE
Dominique Rowell