Medical Referral Specialist Resume Example HSHS Medical Group/ Vita Center For Women

MEDICAL REFERRAL SPECIALIST

Professional Summary

Tenacious Referral Specialist with 12.5 years of successfully working with insurance companies and other medical professionals to obtain prior authorization and set up essential patient appointments. Applies proactive approach to problem-solving and resourceful use of industry network. Knowledgeable making appointments and arranging for continuing coverage of commerical insurance and medicaid patients. Facilitates personable and efficient interactions with insurance and medical providers to maintain seamless workflow. Supports patients from beginning to end of referral process. Fantastic attention to detail, collaboration skills and typing ability. Committed to streamlining organizational procedures to optimize office settings. Capable at handling all medical administrative needs for busy medical practice. Knowledgeable about managing charts, forms and payments. Well-organized and proactive with good judgment and multitasking skills. Maintain high-volume medical office environments by efficiently coordinating files,appointments, physician schedules and office staff schedules. Positive and upbeat with excellent interpersonal communication skills. Goal-oriented and welcoming with proven history of modernizing traditional offices to maximize patient satisfaction. Dedicated to organization and collaboration with over 21 years in medical industry.

Skills

Exceptional communication and customer service.
Exceptional leadership and goal oriented.
Troubleshooting/problem solving.
Interpreting Physician Orders
Appointment Scheduling
HIPAA Compliance
Patient Assistance
Medical Insurance Knowledge
Patient Information Verification
Patient Information Collection

Problem resolution
Process improvement
Relationship development
Communications
Organization
Operational improvement
MS Office
ICD 10 Coding
Epic
EMR

Work History

Medical Referral Specialist, 01/2016 to Current
HSHS Medical Group/ Vita Center For Women – Decatur, IL

Explained plans for treatment and payment options.
Verified insurance benefits and eligibility for surgical procedures, obstetrical benefits, contraceptive benefits.
Coordinated with medical staff and patients to find cost-effective options for genetic testing and contraceptive services
Assisted clients in locating resources that accepted various insurances.
Worked with insurance companies to obtain prior authorization for surgical procedures, genetic testing, obstetrical procedures, botox procedures.
Partnered with hospital departments to provide top-notch service to patients.
Scheduled appointments with specialists on behalf of patients.
Linked families to relevant community support to meet non-medical needs.
Built professional relationships with providers and hospital staff.
Improved timely payment of bills by developing flexible payment plans for patients.
Completed skilled administrative work to support all office staff and operational requirements.
Managed master calendar and scheduled appointments for 15 providers based on optimal patient loads and clinician availability.
Answered phone calls and messages for a 15 provider of obstetrical and gynecological medical office, scheduling appointments and handling patient inquiries.
Coordinated patient scheduling, check-in, check-out and payments for billing.
Coordinated front office duties, including customer service, patient scheduling and billing.
Received, recorded and addressed incoming and outgoing communication via telephone and email.
Organized patient files and streamlined operations to improve efficiency.
Contacted hospitals to confirm patients medical histories and prevent inaccurate diagnoses and treatments.
Frequently double-checked patient histories and current information while scheduling follow-ups and other appointments.
Documented patient medical information, case histories and insurance details to facilitate smooth appointments and payment processing.
Handle all Disability and Family Medical Leave Act Paperwork for all patients.
Handled all Laboratory Billing
Schedule Surgical Procedures done outside our office.

Emergency Communications Specialist, 04/2015 to 08/2015
City Of Decatur – Decatur, IL

Responsible for radio traffic with police officers and giving police officers priority information via radio.
Maintained excellent attendance record, consistently arriving to work on time.
Received public emergency and non-emergency calls and supervised response prioritization in order to effectively dispatch official units such as police, fire and EMS while tracking data in real-time environments.
Routed calls to police, fire and ambulance service to meet individual call needs.

Team Leader Centralized Scheduling, 10/2006 to 07/2015
Decatur Memorial Hospital – Decatur, IL

Responsible for sixteen employees and the day to day operations of centralized scheduling, precertification and fax bank.
Answering up to 600-800 calls per day and entering correct and confidential medical information into hospital scheduling system.
Calling insurance companies and obtaining authorizations for medical procedures and benefits for patients.
Reviewing orders sent by physicians to make sure they meet medical necessity criteria.
Assisting in outpatient registration and admitting.
Resolved scheduling problems, improved operations and provided exceptional client support.

Chiropractic Assistant, 02/2001 to 05/2006
Decatur Back And Neck Center – Decatur, IL

Responsible for assisting doctor with examinations and x-rays of patients.
Promoted office efficiency, coordinating charts, completing insurance forms and helping patients with diverse needs.
Collected and documented patient medical information such as blood pressure and weight.
Enhanced patient outcomes by providing knowledgeable education on procedures, medications and other physician instructions.
Performed variety of therapies on patients, including electric muscle stimulation, massage and mechanical traction.
Contacted insurance carriers to determine patients' coverage and sent invoices for services rendered.
Sanitized, restocked and organized exam rooms and medical equipment.
Taught patients about medications, procedures and care plan instructions.
Directed patients to exam rooms, fielded questions and prepared for physician examinations.
Cleaned exam and therapy rooms and placed used linens in laundry bins for prompt cleaning.
Maintained detailed records of test results by entering data and patient information into computer.
Performed clerical duties, such as word processing, data entry, answering phones and filing.
Obtained client medical history, including medication information, symptoms and allergies.

Education

Certified Nurse Assistant Certification: Certified Nursing Assistant , 1999
Richland Community College - Decatur, IL

High School Diploma: 1998
Warrensburg-Latham High School - Warrensburg, IL

Resume Overview

Companies Worked For:

HSHS Medical Group/ Vita Center For Women
City Of Decatur
Decatur Memorial Hospital
Decatur Back And Neck Center

School Attended

Richland Community College
Warrensburg-Latham High School

Job Titles Held:

Medical Referral Specialist
Emergency Communications Specialist
Team Leader Centralized Scheduling
Chiropractic Assistant

Degrees

Certified Nurse Assistant Certification : Certified Nursing Assistant , 1999
High School Diploma : 1998

Medical Referral Specialist Resume Example

Resume Score: 80%

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