Roderic Fowlks
Lancaster,TX
Summary
Professional with strong background in care coordination with over 15 years of experience. Skilled in patient advocacy, healthcare planning, and resource management. Known for effective team collaboration and achieving measurable results. Adaptable to changing needs with robust communication and organizational skills. Reliable and focused on delivering high-quality care outcomes.
Overview
1
1
Certification
17
17
years of professional experience
Work History
Dual Special Needs Plan Care Coordinator
UnitedHealthcare
Irving, TX
08.2017 - 03.2026
- As a DSNP Care Coordinator Navigator, I closely navigate members as their go-to person with resources to support and educate member with guidance to help handle issues and promote their well-being.
- Managed appointment and transportation arrangements to ensure member access to healthcare Doctor appointments and transportation needs
- Facilitated member access to primary care physicians and specialists, assisting with provider changes as needed.
- Worked to close STAR gaps through enhanced medication adherence and comprehensive health assessments (medication adherence, health assessments, etc.).)
- Collaborated with healthcare providers to streamline communication and referrals.
- Coordinated care plans to enhance patient outcomes and satisfaction.
- Managed patient caseloads effectively, ensuring timely follow-up and appropriate interventions.
Claims Specialist for Provider Services
Aetna
Arlington, TX
05.2015 - 08.2017
- Interpreted codes, reviewed and analyzed bills and claim forms, and investigated discrepancies with doctors and hospitals regarding the status of insurance claims, assuring accuracy. Reached out to provider's office for additional information or to explain reasons behind claim denials.
- Analyzed complex claims data to ensure compliance with regulatory requirements and company policies.
- Collaborated with cross-functional teams to resolve customer inquiries and disputes efficiently.
Medical Insurance Verification Specialist / Promoted to Quality Assurance Specialist
Health Management Services
Irving, TX
02.2009 - 05.2015
- Provides consultation and direction to ensure programs and services are implemented at the highest standards and patients receive the highest level of care. Ensures policies and procedures are monitored and updated to include regulatory changes. Maintained 100% accuracy in a timely manner. Promoted to team-lead 2014 - 2017.
- Worked to ensure that patients' health care benefits cover required procedures. Contacted a patient's insurance company to verify coverage levels and works with individuals to educate them on their benefits information. Maintained 98% accuracy and 22 rph (records per hour).
- Coordinated insurance verification processes to ensure accuracy and compliance with regulatory standards.
- Ensured compliance with HIPAA regulations while managing sensitive patient information during the verification process.
Education
Associate of Arts - Criminal Justice
Southwestern Christian College
Terrell, TX01-2002
High School Diploma -
Duncanville High School
Duncanville, TX01-2000
Skills
- Healthcare Software
- Case management
- Patient education
- Patient advocacy
- Care Coordination
- Specializing in Access of Care and Community Resources
- Clinical Documentation
- Organizational skills
- Medical terminology understanding
- Multitasking and organization
- Administrative patient support
- Resource Navigation
- Communication Skills
Certification
HIPPA Training Certification - UnitedHealthcare, 2017 - current
Timeline
Dual Special Needs Plan Care Coordinator
UnitedHealthcare
08.2017 - 03.2026
Claims Specialist for Provider Services
Aetna
05.2015 - 08.2017
Medical Insurance Verification Specialist / Promoted to Quality Assurance Specialist
Health Management Services
02.2009 - 05.2015
Associate of Arts - Criminal Justice
Southwestern Christian College
High School Diploma -
Duncanville High School