Referral Specialist Resume Example Peach State Health Plan

REFERRAL SPECIALIST

Professional Summary

Tenacious and forward-thinking professional with over 5 years of experience in the healthcare industry working with Medicare beneficiaries and prospects. Highly organized and knowledgeable about healthcare processes associated with the Center for Medicare and Medicaid Services (CMS). Qualified in handling insurance documentation, updating charts, and managing business correspondence. I am a goal-oriented, welcoming professional who is eager to contribute to individual and team success through hard work, attention to detail, and excellent organizational skills. I am also motivated willing to learn, grow, and excel wherever I am.

Skills

Database Management
Physician Authorizations
Insurance Verification
Pre-authorizations
Appointment Reminders
Prospecting
Appointment Scheduling
Multi-line telephone operation
Notetaking and documentation
Insurance coding (ICD-9 and CPT)
Scheduling Software
Medical terminology
MS Office
Problem resolution
Supervision
Project organization
Process improvement

Relationship development
Business operations
Operational improvement
Google Suite
Time management
Planning
Organizing
Presentation
Research
Detail-oriented
Budgeting
Management accounting
Presentation skills
Customer service
Written and verbal communication
Program development
Informational material development

Work History

Referral Specialist03/2018 to Current
Peach State Health Plan – Atlanta , GA

Improved operational performance without sacrificing quality by developing and implementing diverse approaches.
Oversee and maintain error report spreadsheets, to ensure Medicaid requirements for requests are met in a timely manner.
Assisted clients in locating resources that accepted various insurances.
Partnered with other departments, including pharmacy to provide top-notch service to clients.
Worked with providers to obtain prior authorization for outpatient and inpatient procedures.
Built professional relationships with service providers.
Verified insurance benefits and eligibility for providers before processing authorization requests.
Entered prior authorization data using TurCare/cloud software to document referrals and results.
Completed up to 50 authorization requests each day for medical providers for services.
Reviewing incoming phones calls and case management, log reports and determine course of action (i.e. set up authorization or denial and send to nurse reviewer)
Contacted hospitals to confirm patients medical histories and prevent inaccurate diagnoses and treatments.
Received, recorded and addressed incoming and outgoing communication via telephone and email.
Documented patient medical information, case histories and insurance details to facilitate smooth appointments and payment processing.

Medicare Outreach Coordinator 06/2014 to 12/2017
Independence Blue Cross – Philadelphia , PA

Liaised with corporate sales and marketing teams to develop and maintain social media promotion, email-based campaigns and other marketing programs.
Conducted presentations to expose and increase product and service awareness in marketplace to Medicare beneficiaries.
Generated interest in Medicare advantage products and services, identified new markets and educated prospective clients on benefits.
Created and implemented print and digital public awareness campaign to increase awareness of Medicare services.
Developed network relationships with industry professionals to enhance community awareness and promote services.
Pursued yearly growth targets through strong leadership, analysis, problem-solving, team building and coaching.
Initiated and coordinated visits by influential persons and community groups for marketing exposure.
Scheduled yearly outreach exhibitions and educated employees on tasks related to Medicare enrollment/dis enrollment and services for beneficiaries.
Identified, developed and administered grants in accordance with funder requirements.
Increased education and awareness of products and services through educational programs and delivering evidenced-informed strategies.
Referred clients to appropriate team members, community agencies and organizations to meet treatment needs.
Spoke with community organizations to boost outreach and highlight programs successes.
Conducted community workshops to promote different programs and educate public on available services.
Coordinated schedules and assignments for volunteer staff, maximizing team efficiency and effectiveness.
Worked with senior case managers to coordinate team development activities and trainings.
Developed and implemented variety of innovative policies and strategies to promote client self-sufficiency.
Optimized operational systems to maintain effective budgets and accurate documentation for permanent records.
Developed and updated policies and procedures, maintaining compliance with statutory, regulatory and local, state and federal guidelines relating to HIPAA, benefits administration and general liability.
Oversaw all financial transactions and management functions, strategically managing $1.5M operating budget.
Offered patients and patrons information on various immunizations including flu, DTaP and HPV vaccines.
Generated and submitted invoices based upon established accounts receivable schedules and terms.
Maintained excellent attendance record, consistently arriving to work on time.
Conducted presentations to expose and increase products and services awareness in marketplace.
Generated interest in products and educated prospective clients on benefits.

Customer Service Representative02/2013 to 06/2014
Independence Blue Cross – Philadelphia , PA

Offered advice and assistance to customers, paying attention to special needs or wants.
Achieved and consistently exceeded revenue quota through product and service promotion during routine calls.
Answered constant flow of customer calls with up to several calls in queue per minute.
Recommended products and service to customers, thoroughly explaining details.
Answered customer telephone calls promptly to avoid on-hold wait times.
Consulted with outside parties to resolve discrepancies and create effective solutions.
Provided primary customer support to internal and external customers in fast-paced environment.
Responded to customer requests for products, services and company information.
Used company troubleshooting resolution tree to evaluate technical problems while leveraging personal expertise to find appropriate solutions.
Liaised with customers, management and sales team to better understand customer needs and recommend appropriate solutions.
Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
Cultivated customer loyalty, promoted repeat customers and improved sales.
Evaluated account and service histories to identify trends, using data to mitigate future issues.
Entered customer interaction details in company software to track requests, document problems and record solutions offered.
Educated customers on promotions to enhance sales.

Education

Bachelor of Science: Business09/2020University of Phoenix- Tempe, AZ

Minored in Marketing
Member of Alumni Association

H.S Diploma: Liberal Arts And SciencesJohn Bartram - Philadelphia, PA

Resume Overview

Companies Worked For:

Peach State Health Plan
Independence Blue Cross

School Attended

University of Phoenix
John Bartram

Job Titles Held:

Referral Specialist
Medicare Outreach Coordinator
Customer Service Representative

Degrees

Bachelor of Science : Business 09/2020
H.S Diploma : Liberal Arts And Sciences

Referral Specialist Resume Example

Resume Score: 80%

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