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Referral Authorization And Billing Specialist Resume Example

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Jessica Claire
  • Montgomery Street, San Francisco, CA 94105
  • H: (555) 432-1000
  • C:
  • resumesample@example.com
  • Date of Birth:
  • India:
  • :
  • single:
Professional Summary

PROFESSIONAL OBJECTIVE: Seeking a highly stimulating position with challenging opportunities where I may utilize my extensive experience in medical procedures and preparation, vital signs management, office administration and bilingual skills. SUMMARY OF QUALIFICATIONS: Competent in a broad range of medical/secretarial functions.

Skills

Obtained patient medical history

  • Vital Signs
  • Bill payment
  • Administered Medication
  • Venipuncture
  • Injections
  • In-House Lab Test - Throat cultures, Urinalysis
  • SECRETARIAL
  • Credentialing/Re-credentialing
  • Typed Correspondence - Word Perfect and Microsoft word
  • Data entry
  • Scheduled appointments, Radiological testing, Pre-certification
  • Transportation arrangements and meetings
  • Answered multiple telephone lines
  • Verified Insurer/Insurance /Referrals-Envoy and Internet
  • Collect Co-pays
  • Posted charges
  • Filed and performed other general office duties
  • Charts, Urinalysis
  • Closing, Veni-puncture
  • Data entry, Vital Signs
  • Dictation, Word Perfect
  • EKG, X-Ray
  • Injections
  • Insurance

  • Microsoft word
  • SECRETARIAL
  • Telep

  • Customer service excellence
Work History
Referral, Authorization and Billing Specialist, 05/2016 to Current
Virginia Hospital Center Mclean, VA,
  • Completed up to 20 to 30 Referral, Pre authorization, PreDetermination requests each day for medical provider of Plastic Surgery and Dermatology services.
  • Organized clinical documentation, treatment plans, and referrals.
  • Trained 15 staff on referral and intake process.
  • Maintained accurate records on in-progress and completed Referrals, Pre Authorizations and Pre Determination ensuring full data integrity throughout process.
  • Called insurance companies to get precertification and other benefits information on behalf of patients.
  • Contacted clients with past due accounts to formulate payment plans and discuss restructuring options.
  • Worked effectively with medical payers such as Medicare, Medicaid, commercial insurances to obtain timely and accurate payments.
  • Documented case notes daily and coordinated follow-up for seamless case management.
  • Followed up with customers on unresolved issues.
  • Reported policy changes and company conditions affecting customer satisfaction.
  • Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
  • Conducted annual reviews of existing policies to update information.
  • Collected all premiums on or before effective date of coverage.
  • Tracked progress of all outstanding insurance claims.
Medical Assistant, 11/2014 to 01/2016
Giant Eagle, Inc. Solon, OH,
  • Obtained client medical history, including medication information, symptoms and allergies.
  • Supported duties for diagnostic and technical treatment procedures, such as setting up and operating special medical equipment and apparatus.
  • Prepared patients for X-rays, electrocardiograms, suture removal and dressing changes.
  • Completed clinical procedures and gathered patient data for interpretation by physician.
  • Implemented care and efficiency improvements to support and enhance office operations.
  • Explained procedures to patients to reduce anxieties and increase patient cooperation.
  • Enhanced patient outcomes by providing knowledgeable education on procedures, medications and other physician instructions.
  • Communicated clearly and effectively with patients to verify information, determine purpose of visit and record medical history.
  • Conducted preliminary evaluations, including measuring weight, temperature and blood pressure, and documented results with accuracy.
  • Ensured collection of lab specimens by appropriate lab courier.
  • Participated in Continuous Quality Improvement (CQI) activities.
  • Escorted patients to examination rooms.
  • Promoted office efficiency, coordinating charts, completing insurance forms and helping patients with diverse needs.
  • Attended required training, education and meetings.
  • Welcomed patients and inquired about wellbeing since last treatment.
  • Obtained all prescribed laboratory testing.
  • Tested and recorded blood glucose levels.
  • Report significant information and changes in patient condition to nurse supervisor.
  • Prepared blood, urine, stool and sputum lab specimens for diagnostic evaluation.
  • Conducted machine safety checks according to facility policy.
  • Performed clerical duties, such as word processing, data entry, answering phones and filing.
  • Collected and documented patient medical information such as blood pressure and weight.
  • Measured patient pulse oximetry.
  • Assisted physicians in follow-through of care.
  • Performed or scheduled preventive maintenance on equipment to promote longevity of use, troubleshooting technical issues and coordinating repairs.
  • Submitted prescriptions to pharmacy via phone, fax or web.
Caterer, 05/2004 to 12/2014
James River Home Health And Hospice Lynchburg, VA,
  • Created catering menu based upon client specifications, event type, dietary needs and budget.
  • Ordered food items and supplies needed to fulfill catering jobs.
  • Crafted exciting catering options for clients, including pig roasts, corporate picnics, outdoor sit-down wedding banquets and seaside clambakes.
  • Collaborated with clients to plan event menus, budgets, and venues.
  • Transported meal and beverage trays from kitchen and bar areas to serve guest tables.
  • Cleaned, sanitized and organized foodservice equipment, including serving utensils, trays and station counters.
  • Communicated with event coordinators to ensure and facility management to ensure adequate and appropriate accommodations.
  • Set up and disassembled food service stations, equipment and furniture per guest or contract specifications.
Phlebotomy Technician, 01/2010 to 05/2014
The Heart Center City, STATE,
  • Validated blood and specimen collection orders, alerting nurses or physicians of discrepancies between order and nursing station logs.
  • Collected fluid or tissue samples by using appropriate collection procedures.
  • Followed physician orders when administering therapeutic phlebotomy.
  • Accurately labeled vacutainer tubes with patient name, date and time of collection.
  • Resolved unusual test orders by contacting physicians, nursing stations or reference laboratories.
  • Obtained blood specimens by performing venipunctures and finger sticks 40-50 times per day.
  • Organized daily work based on collection priority.
Education
Cerification: Medical Assistant Program, Expected in 1995
to
National School of Technology - Hialeah, Florida,
GPA:
High School Diploma: , Expected in 1984
to
Ossining High School - Ossining, NY,
GPA:

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Resume Overview

School Attended
  • National School of Technology
  • Ossining High School
Job Titles Held:
  • Referral, Authorization and Billing Specialist
  • Medical Assistant
  • Caterer
  • Phlebotomy Technician
Degrees
  • Cerification
  • High School Diploma

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