referral coordinator prior authorization rep resume example with 12+ years of experience

Jessica Claire
  • Montgomery Street, San Francisco, CA 94105 609 Johnson Ave., 49204, Tulsa, OK
  • Home: (555) 432-1000
  • Cell:
  • :
Professional Summary

Forward-thinking professional offering more than 9 years of experience working in fast-paced environments. Highly motivated and eager to learn.

  • Prior authorization processing
  • Obtaining authorizations
  • Record preparation
  • Mail preparation and sorting
  • Referral arrangements
  • Patient referrals
  • Organization and prioritization skills
  • Supply reporting
Work History
Referral Coordinator / Prior Authorization Rep , 08/2015 to Current
SafewayKeizer, OR,
  • Completed up to 30 referral requests each day for medical providers.
  • Called insurance companies to get precertification and other benefits information on behalf of patients.
  • Preserved and prepared reports and treatment records.
  • Organized clinical documentation, treatment plans, and referrals.
  • Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
  • Fielded telephone inquiries on authorization details from plan members and medical staff.
  • Verified eligibility and compliance with authorization requirements for service providers.
  • Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
  • Communicated pertinent information to client's prescribing provider to facilitate quality service.
  • Processed new medication and refill requests for authorization.
  • Contacted insurance companies to obtain prior authorization for medical procedures and medications.
  • Edited letters and written material for correspondence.
  • Researched denied claims and contacted insurance companies to resolve these issues.
  • Removed all debris and packaging from boxes and separated for recycling or disposal.
  • Accepted delivered packages, verified products and checked delivery totals to keep system records current and accurate.
  • Evaluated supplies and product inventory to check for quality and quantity issues and returned unacceptable materials to vendors to obtain replacements or refunds.
  • Maintained accuracy, completeness and security for medical records and health information.
  • Received and routed medical records.
  • Prepared mailings of information and documentation.
  • Sorted materials and filed according to guidelines.
  • Weighed letters and packages and calculated costs based on classification, weight and destination.
Deli Manager, 12/2012 to 08/2015
Roberts GroceryCity, STATE,
  • Set and enforced performance and service standards to keep consistent, high-quality environment devoted to customer satisfaction.
  • Inspected preparation and storage equipment regularly to assess and maintain performance for cost-effective, safe operations.
  • Limited portion sizes and used garnishes to control food costs.
  • Maintained high standards of food quality by reviewing shipments, overseeing preparation and monitoring food safety.
  • Inventoried food products and associated materials on Timeframe basis.
  • Reviewed pricing and ordered food ingredients, kitchen appliances and supplies.
  • Controlled inventory costs by carefully managing portion control and reducing waste.
  • Oversaw balancing of cash registers, reconciled transactions and deposited establishment's earnings to bank each Timeframe.
  • Assisted customers by answering questions and fulfilling requests.
  • Researched issues to obtain appropriate answers to customer inquiries.
  • Effectively allocated tasks during high-traffic times to keep operations running smoothly and employees focused.
  • Trained new associates on cash register operations including opening, conducting customer transactions and balancing drawer.
  • Aligned inventory processes with demand projections to maximize organizational and budget efficiency.
  • Implemented daily operating procedures to keep store clean, adequately stocked and well-organized.
  • Offered hands-on assistance to customers, assessing needs and maintaining current knowledge of consumer preferences.
  • Assisted customers with locating and choosing merchandise in any store department.
  • Opened and closed store independently when needed and prepared nightly bank drop for manager.
Office Floater, 09/2008 to 12/2012
Dothan Pediatric ClinicCity, STATE,
  • Carried out front office duties utilizing data entry skills in framework of medical database.
  • Facilitated organized record retrieval and access by maintaining filing system for both in-house and discharged residents.
  • Received, recorded and addressed incoming and outgoing communication via telephone and email.
  • Organized paperwork such as charts and reports for office and patient needs.
  • Frequently double-checked patient histories and current information while scheduling follow-ups and other appointments.
  • Located, checked in and pulled medical records for patient appointments and incomplete charts.
  • Successfully scheduled patient appointments and placed reminder calls to deliver exceptional customer experience.
  • Coordinated front office duties, including customer service, patient scheduling and billing.
  • Maintained confidentiality of patient finances, records and health statuses.
  • Completed clerical duties and tasks for clinic administration.
  • Verified and updated demographic and other personal information for clients with respect to personal boundaries when asking for important details.
  • Removed invalid computer alerts and cleaned accounts to assure information accuracy.
Graduate : , Expected in 05/2003 to Rehobeth High School - Dothan, AL

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Resume Overview

School Attended

  • Rehobeth High School

Job Titles Held:

  • Referral Coordinator / Prior Authorization Rep
  • Deli Manager
  • Office Floater


  • Graduate

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