Summary
Overview
Work History
Education
Skills
Timeline
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Tomie Faulkner

Batavia,OH

Summary

Dynamic professional with extensive experience at Anthem, excelling in claims processing and policy interpretation. Proven ability to enhance team collaboration and ensure quality assurance. Skilled in documentation review and patient education, leveraging strong attention to detail to achieve optimal outcomes in both insurance and dental environments.

Overview

25
25
years of professional experience

Work History

Claims Rep II

Anthem
Cincinnati, OH
10.2021 - 01.2025
  • Collaborated with team members to resolve complex claim issues and discrepancies.
  • Maintained accurate records of claims submissions and correspondence for auditing purposes.
  • Processed a high volume of claims efficiently while maintaining quality standards.
  • Reviewed and verified claim information to ensure accuracy of data and compliance with established policies.
  • Processed claims efficiently using Anthem's proprietary claims management system.
  • Adhered to strict guidelines pertaining to confidentiality while handling sensitive personal information.
  • Ensured timely submission of required documentation from claimants prior to approval of payment.
  • Managed asset recoveries for claims, including salvage, and subrogation.
  • Identified potential fraud indicators during the review process and reported suspicious activity accordingly.

Dental Hygienist

Neil Blackburn
Amelia, Ohio
04.2002 - 08.2021
  • Paperless office utilizing Dentrix and Dexis software.

  • Provided patient education on oral hygiene practices and preventive care.
  • Conducted thorough dental cleanings using ultrasonic scalers and hand instruments.
  • Assisted dentists during procedures by preparing instruments and materials.
  • Maintained accurate patient records and documented treatment plans effectively.
  • Implemented infection control protocols to ensure a safe environment for patients.
  • Collaborated with team members to improve workflow and enhance patient experience.
  • Scheduled appointments and managed patient flow within the office efficiently.
  • Developed treatment plans based on diagnosis and discussed with dentists.
  • Studied new and advanced dental hygiene methods and technology by completing continuing education coursework.
  • Performed root planing procedures to remove plaque from below the gum line.

Dental Hygienist

Robert Lammare
Cincinnati
07.2000 - 04.2002
  • Provided patient education on oral hygiene practices and preventive care.
  • Conducted thorough dental cleanings using ultrasonic scalers and hand instruments.
  • Maintained accurate patient records and documented treatment plans effectively.
  • Implemented infection control protocols to ensure a safe environment for patients.

Education

High School Diploma -

Glen Este High School
Cincinnati, OH
06-1989

Associate of Applied Science -

Raymond Walters College
Blue Ash, OH

Skills

  • Claims processing
  • Policy interpretation
  • Quality assurance
  • Effective communication
  • Attention to detail
  • Time management
  • Team collaboration
  • Coverage assessments
  • Documentation review
  • Insurance claims review
  • Flexible schedule
  • Coverage determination
  • Patient education
  • Dental software
  • Infection control
  • Treatment planning
  • Local anesthesia administration
  • Dental radiography
  • Digital radiography
  • Patient management
  • Dental records
  • Dentrix software proficiency

Timeline

Claims Rep II

Anthem
10.2021 - 01.2025

Dental Hygienist

Neil Blackburn
04.2002 - 08.2021

Dental Hygienist

Robert Lammare
07.2000 - 04.2002

High School Diploma -

Glen Este High School

Associate of Applied Science -

Raymond Walters College

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