Sandra Fowler
Insurance Specialist
Fosters,AL
Summary
Proven Insurance Specialist with a track record of enhancing customer satisfaction and streamlining claims management at The Radiology Clinic/Simplified Medical Management. Leveraged expertise in policy knowledge and exceptional problem-solving abilities to resolve complex insurance issues, contributing to significant revenue generation. Demonstrates professionalism and teamwork, ensuring regulatory compliance and high service standards.
Overview
43
43
years of professional experience
Work History
Insurance Specialist
The Radiology Clinic/Simplified Medical Management
2008.12 - Current
- Enhanced customer satisfaction by addressing insurance-related inquiries and resolving issues promptly.
- Processed eligibility and benefits verification.
- Followed up on denials, late payments, extensions and other special circumstances.
- Tracked pending authorizations to resolve discrepancies and avoid revenue loss.
- Maintained high standards of customer service by building relationships with clients.
- Resolved discrepancies in insurance payments by collaborating with carriers.
- Communicated effectively with members of operations, finance, and clinical departments.
- Maintained a high level of industry expertise through continuous professional development courses and certifications in the field of insurance specialty.
- Researched and resolved routine and complex issues.
- Ensured regulatory compliance through diligent monitoring of company practices and adherence to guidelines.
- Contributed to team performance by sharing industry knowledge and assisting colleagues in complex cases.
- Trained new hires on company policies and procedures, ensuring a seamless transition into the Insurance Specialist role.
- Maintained confidentiality of patient finances, records, and health statuses.
- Provided exceptional service to clients by guiding them through the claims process step by step.
- Responded to customer calls swiftly to resolve issues and answer questions.
- Investigated and processed claims swiftly to keep customers satisfied.
- Monitored changes in insurance industry to stay compliant with relevant laws and regulations.
- Built relationships with clients using active listening and issue resolution to provide excellent service.
- Educated clients on insurance policies and procedures.
Dental Receptionist
G Norman Carlson, DMD
1988.03 - 2008.10
- Scheduled, rescheduled, and cancelled appointments for dental patients.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Provided excellent customer service by promptly addressing patient inquiries via phone, email, or in-person interactions.
- Provided excellent customer service to create positive experiences and build patient trust.
- Communicated with insurance companies to dispute unpaid claims and verify patient coverages.
- Handled sensitive situations professionally such as discussing treatment costs or past-due account balances with patients to ensure a satisfactory resolution.
- Helped patients complete necessary medical forms and documentation.
- Improved billing accuracy by diligently verifying insurance coverage and updating patient financial records accordingly.
- Enhanced patient satisfaction by efficiently managing appointment scheduling and confirmations.
- Prepared insurance claim forms, explained benefits, and outlined pricing details for procedures and services.
- Promoted a positive work environment by fostering strong relationships with colleagues across all roles within the practice.
- Greeted visitors and patients to determine needs, check appointments, and direct accordingly.
- Completed patient referrals to other medical specialists.
- Adhered to strict HIPAA guidelines to protect patient privacy.
- Managed accounts receivable duties by timely invoicing patients for services rendered while tracking payments received or outstanding balances due accurately.
- Increased office efficiency with meticulous record-keeping of patient information, treatment plans, and payment history.
- Managed patient billing processes for timely, accurate payments.
- Handled patient complaints quickly and professionally to restore patient confidence and prevent loss of clientele.
- Secured sign-in sheets, dental charts, and encounter forms to safeguard sensitive data and information.
- Collaborated with team members to maintain an organized inventory system for dental supplies and office materials.
- Understood dental terminology and insurance breakdowns to communicate with external stakeholders.
- Ensured patient privacy by adhering to all HIPAA regulations during the collection, storage, and sharing of sensitive information.
- Streamlined insurance claims processing for faster reimbursement and improved patient experience.
- Participated in ongoing training workshops or seminars to stay updated on industry trends and best practices in dental administration management.
- Greeted and interacted with patients to provide information, answer questions and assist with appointment scheduling.
- Obtained payments from patients and scanned identification and insurance cards.
- Performed various administrative tasks by filing, copying and faxing documents.
- Prepared and processed patient referrals and transfer requests.
- Answered phone calls and messages for four general dentist scheduling appointments, and handling patient inquiries.
Dental Assistant
George Hartley, DMD
1986.03 - 1988.03
- Cleaned and sanitized dental tools and equipment, straightened treatment rooms, and restocked supplies to prep for next patient and maintain health and safety practices.
- Maintained a clean and sterile work environment to prevent cross-contamination and infection.
- Sanitized trays, instruments, and surfaces for clean dental office setting and patient safety.
- Provided chairside assistance during examinations, improving dentist efficiency and patient satisfaction.
- Performed x-rays safely while adhering to radiation safety guidelines, ensuring high-quality diagnostic images for dentists'' evaluations.
- Prepared and arranged instruments, medications, and required materials for dental procedures.
- Successfully assisted dentist by performing four-handed dentistry and other chair-side duties.
- Sterilized rooms and prepped equipment and instruments for procedures daily.
- Performed general chair-side duties for general dentistry, endo procedures, and oral surgery.
- Assisted dentists with complex procedures, ensuring optimal patient care and treatment outcomes.
- Documented patient dental health information, medical history.
- Assisted dentists with appropriate tools and supplies needed for procedures.
- Prepared instruments and equipment for use in dental procedures, ensuring their availability when needed.
- Created dental impressions used for diagnostics, opposing models and study casts to make crowns, bridges, and other dental prosthetics.
- Maintained dental supply inventory by checking stock to determine inventory levels and placing and expediting orders for supplies.
- Prepared patient x-rays and images for dentist review.
- Took dental images following strict patient protection rules, applying lead aprons.
- Recorded patients' health histories, documented current symptoms, and pulled up records from prior visits for dentists to view and evaluate.
- Educated patients on proper oral hygiene techniques, promoting long-term dental health.
- Contributed to office organization by maintaining accurate patient records and updating files regularly.
- Prepared and positioned patients for procedures, clipping dental napkins and placing patient safety devices.
Cosmetologist
Joyce Farmer
1981.01 - 1986.03
- Maintained a clean and hygienic work environment by following strict sanitation guidelines and procedures.
- Demonstrated high level of customer service.
- Demonstrated exceptional time management skills by efficiently scheduling appointments and managing multiple clients simultaneously.
- Enhanced client satisfaction by providing personalized cosmetology services based on individual needs and preferences.
- Attended regular trainings and workshops to maintain cosmetology license and stay current on technique and skills.
- Researched latest trends in hair and makeup to stay updated on color, style, and techniques
- Suggested treatments and styles to suit customer appearance and fashion choices.
- Shampooed, conditioned, and rinsed guests' hair using salon-exclusive products while educating clients on product benefits to increase product sales.
- Maintained regular client list and successfully handled walk-in customers.
- Styled hair, makeup and nails for customers for special events and occasions.
- Offered professional cuts, color services to salon customers.
- Attended hair shows, classes and seminars to stay up-to-date on latest trends.
Education
Shelton State Community College of Cosmetology
Tuscaloosa, AL05.1981
Tuscaloosa County High School
Northport, AL05.1980
Skills
- Claims Management
- Customer Service
- Medical and dental insurance
- Claims reporting systems
- Deductible Expense Identification
- Policy Knowledge
- HIPAA Compliance
- Multitasking Abilities
- Insurance Claim Regulations
- Claims Information Gathering
- Policy Changes
- Problem-solving abilities
- Insurance Eligibility
- Time Management
- Professionalism
- Organizational Skills
- Teamwork and Collaboration
- Professional Demeanor
- Billing Procedures
- Customer Account Review
- Customer Service
Work Preference
Work Type
Full TimeWork Location
On-SiteRemoteHybridImportant To Me
Paid sick leave401k matchPaid time offAccomplishments
I have written and updated SOP's. This is to assist the insurance department when someone needs help with their insurance or if a co-worker is out for any amount of time. It also helps when training a new employee.
When I was first hired, Alabama Medicaid was just starting to require prior authorizations. Not only was I new to medical insurance but this was new to us all. I was able to put in place away to train others in the insurance department and area doctor offices what procedures need the prior authorizations and the time limit to obtain the prior authorization or request a new one.
Over the years I have been asked to help my co-workers with sending reports, drug invoices and any other information the insurance requests in order to pay the claim.
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Insurance Specialist
The Radiology Clinic/Simplified Medical Management
2008.12 - Current
Dental Receptionist
G Norman Carlson, DMD
1988.03 - 2008.10
Dental Assistant
George Hartley, DMD
1986.03 - 1988.03
Cosmetologist
Joyce Farmer
1981.01 - 1986.03
Shelton State Community College of Cosmetology
Tuscaloosa County High School
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