Sandra Rodriguez
Grand Terrace
Summary
Results-driven professional with a versatile background in healthcare intake and reimbursement. Recognized for strong attention to detail and effective multitasking abilities, ready to support operational excellence and client satisfaction.
Overview
25
25
years of professional experience
Work History
Senior Intake, Representative
National Cornerstone Healthcare Services
Loma Linda, California
07.2014 - 11.2016
- Facilitated patient intake processes, ensuring accurate data collection and compliance with healthcare regulations.
- Coordinated communication between patients and healthcare providers to streamline appointment scheduling and reduce wait times.
- Implemented process improvements to enhance patient experience and optimize workflow efficiency within the intake department.
- Trained new staff on intake procedures, policies, and best practices to ensure consistency in service delivery.
- Increased client satisfaction with timely follow-ups and comprehensive information on available services.
- Coordinated seamless transitions between intake and service delivery teams, minimizing disruption for clients.
Intake/Reimbursement Manager
Caremark Specialty Pharmacy
Redlands California
04.1999 - 06.2014
- Managed reimbursement processes ensuring compliance with regulatory standards.
- Collaborated with cross-functional teams to streamline claim submission workflows.
- Developed training materials for staff on reimbursement policies and procedures.
- Analyzed billing discrepancies, implementing corrective actions to improve accuracy.
- Observed strict data confidentiality procedures to protect patients' information.
- Conducted regular audits of reimbursement activities, identifying areas for improvement and implementing corrective actions as needed.
- Managed monthly, quarterly and annual payouts for merit rewards, sales commissions and bonus programs.
- Monitored and documented accounts receivable trends and account-specific profitability.
- Trained department employees in proper billing and accounting procedures.
- Guided office staff on how to effectively complete prior authorization forms and appeals documentation to achieve positive results.
- Coordinated with insurance providers to verify customer's policy benefits in relation to claims.
- Helped minimize escalations by reaching out to clients in advance of expected problems.
- Developed strong relationships with insurance companies and healthcare providers, fostering collaboration and ensuring smooth communication for reimbursement matters.
- Collaborated with insurance providers to clarify requirements and ensure proper submission of claims for faster processing times.
- Managed a team of reimbursement specialists, providing guidance and support for optimal performance.
- Streamlined communication between departments involved in the reimbursement process, fostering collaboration and accuracy.
- Reviewed billing and collections process and determined improvements to streamline workflows.
- Maintained up-to-date knowledge on national healthcare policies affecting reimbursements, advising senior leadership on necessary adjustments or updates to internal processes accordingly.
- Provided exceptional customer service when addressing patient inquiries about their reimbursements, resolving issues promptly and professionally.
Third-party Administrator, Representative
Shared Medical Alternatives
Riverside California
04.1992 - 06.1999
- Assisted customers with insurance inquiries, providing accurate information and resolving issues efficiently.
- Developed solutions for customer complaints, improving overall satisfaction ratings through effective communication.
- Supported cross-functional teams in implementing new software tools, enhancing operational workflows across departments.
- Managed high call volume while maintaining professionalism, empathy, and attention to detail in each interaction.
- Processed policy updates and changes accurately, ensuring client needs were met in a timely manner.
- Answered incoming phone calls to articulate product value to prospective customers and support current policyholders.
- Handled sensitive customer information with discretion, adhering to strict data privacy regulations at all times.
- Documented customer interactions and transactions for accurate, up-to-date records.
- Enhanced customer satisfaction by addressing and resolving insurance-related inquiries and concerns.
- Assisted customers with completing insurance documents to avoid missed information.
- Conducted comprehensive policy reviews for clients, identifying gaps in coverage and recommending appropriate solutions.
- Trained new customer service representatives on best practices, policies and procedures.
- Provided exceptional support during annual open enrollment periods, guiding customers through plan selection processes effectively.
Reimbursement Lead
BMR Partners
Ontario,CA
12.2016 - 2025
- Assisted with day-to-day operations, working efficiently and productively with all team members.
- Organized and detail-oriented with a strong work ethic.
- Used critical thinking to break down problems, evaluate solutions, and make decisions.
Education
High School Diploma -
Pacific High. School
San Bernardino, CASkills
- Friendly, positive attitude
- Teamwork and collaboration
- Customer service
- Problem-solving
- Attention to detail
- Dependable and responsible
- Multitasking
- Computer skills
- Decision-making
- Problem resolution
Timeline
Reimbursement Lead
BMR Partners
12.2016 - 2025
Senior Intake, Representative
National Cornerstone Healthcare Services
07.2014 - 11.2016
Intake/Reimbursement Manager
Caremark Specialty Pharmacy
04.1999 - 06.2014
Third-party Administrator, Representative
Shared Medical Alternatives
04.1992 - 06.1999
High School Diploma -
Pacific High. School