SANDRA REGINA LAWSON

**** ******* *******, ** ***** • 517-***-**** • ad1an6@r.postjobfree.com

WORK EXPERIENCE

Patient Access Rep - Internal Medicine Clinic - McLaren Medical Physician Lansing, MI September 2018 to Present in

● Schedule patient appointments.

● Update patient information - address, insurance and other pertinent to information Speak with office staff regarding referral to specialist - make sure staff ischeduling with in-network physicians

Reconcile physician schedules to insure compliance with the physician orders/request Verify insurance coverage before scheduling new patients and current patients Notify patient of deductible or co-pays at the time of service. Verification Specialist/Billing Department Kerry St. - a Medical Group Lansing, MI September 2016 thru February 2016 Aerotek Staffing February 2016 to present McLaren employee

● Verification of all member insurance via phone and website -;BCBS, HMO, PPO and TPA

● Data entry of patient information in Patient Portals

● Verify email address so medical information can be obtained by patient portals - patient can review labs

medication and test results

Medical Benefit Coordinator - Physicians Health Plan, Lansing, MI May 2013 – January 2016

● Process and organize non-clinical review requests.

● Monitor inpatient hospital utilization using EPIC software.

● Respond to incoming phone calls from internal departments and external customers.

● Documentation of all inquiries, Template of calls for inpatient and outpatient surgical request.

● Assist in directing members to network providers to manage medical cost.

● Assist case managers with tracking members who require complex case management services.

● Work within established timelines for approval and denial of services.

● Assist Utilization staff to identify members with health issues that can be documented in the HEDIS study i.e. diabetes, high blood pressure, asthma

● Working with member benefits under their insurance plan ie Medicaid/Medicare/PPO and TPA product

Release of Information Coordinator - Sparrow Health System, Lansing, MI July 2010 – May 2013

● Received medical records request via mail, phone or walk-in.

● Assess requests for information based on HIPAA policies and Sparrow regulations, question requestor to obtain all the information needed to complete request.

● Educated and served as a resource for all medical record inquiries.

● Generated reports for Quality Improvement Department and Risk Management Department with EPIC software.

● Maintained a record of all requests for medical data and any information pertaining to the data.

● Tracked HEDIS measures with data compiled thru the EPIC software. External Review Analyst - Sparrow Health System, Lansing MI March 2005 – July 2010

● Received and evaluated all request for records for internal and external review.

● Coordinated details of review with requestor regarding space needed, dates and times.

● Coordinated medical record retrievals, review, scanning and mailing as needed.

● Served as point of contact for onsite medical reviewers Client Care Coordinator II - Gentiva Home Health Care, East Lansing MI September 2001 – April 2004

● Completed and reviewed clinical records for Medicaid/Medicare OASIS report for the State of Michigan.

● Obtained requested patient charts for URAC and State of Michigan standards for review.

● Recruit,Interview and Supervise new HHA and Companions, train and develop weekly schedules for home visits and monthly inservices

● Communicated with home care staff - patient schedule and client needs, monitor patient care monthly for compliance with Gentiva’s standard of care. s.lawson

Provider Relations Representative - The Wellness Plan, Lansing MI October 1996 - February 2000

● Liaison for three counties in the Lansing area (Ingham, Eaton and Clinton).

● Work with provider with claims, membership reconciliation payment, training of staff on the Medicaid enrollment and retention.

● Work with the marketing department, to promote membership through community activities. EDUCATION

● Wayne State University, Detroit, MI

● Medical Secretary Program - Carnegie Institute, Troy, MI SKILLS

● Microsoft Office proficiency

● EPIC EMR software experience

● HEDIS database proficiency

● CHAMPS (Medicaid/Medicare enrollment, billing and coding) software References Upon Request