LiveCareer-Resume

referral specialist resume example with 13+ years of experience

Jessica Claire
  • , , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
  • Home: (555) 432-1000
  • Cell:
  • resumesample@example.com
Summary

Flexible and versatile Business Analyst specializing in developing innovative solutions to organizational problems. Advanced knowledge of asset tracking software. Committed to providing accurate, effective advice to customers.

Creative Business Analyst with broad-based background in highly competitive and dynamic organizations. Recognized as decisive leader and excellent team player. Committed to forming strong, productive teams.

Qualified Business Intelligence Analyst versed in data mapping and user acceptance testing to solve complex problems in high-pressure environments. Activates strong analytical skills to investigate trends in large amounts of data and formulate conclusions based on findings. Excels at cultivating, managing and leveraging client relationships to foster extended engagements and business opportunities.

Skills

Working in different insurance remotes

Billing multiple insurances for payment

Account resolution

Teamwork participation

Open to new ideas

Working and assisting Management

  • MS Office expertise
  • Multitasking
  • Active listening
  • Troubleshooting
  • Teambuilding
  • Relationship building
  • Friendly, positive attitude
  • Computer skills
  • Microsoft Office
Experience
Referral Specialist, 05/2021 to Current
Uc HealthAurora, CO,
  • Tracked referral request progress and resolved issues to maintain smooth processing.
  • Assisted patients by answering questions and providing information regarding referrals.
  • Entered confidential patient information and updated electronic records in database.
  • Managed and obtained insurance authorizations for patient referrals from physicians.
  • Contacted patients to confirm or reschedule appointments to minimize no-show appointments.
  • Aided clinical team to support administrative needs for clinical referrals.
  • Gathered and verified insurance requirements to meet payer requirements.
  • Obtained PA for services such as diagnostic imaging.
  • Liaised with healthcare facility personnel, insurance representatives, physicians and vendors for smooth communication.
  • Communicated with insurance representatives to gather information and verify patient benefits to determine clearance form services.
  • Collected required signatures to initiate referral process.
  • Worked closely with financial counselors to guide patients on financial obligations and decision-making.
  • Scheduled patients according to availability, urgency and insurance authorization guidelines.
  • Managed up to several patient referrals daily through multi-line telephone system.
  • Communicated with insurance representatives to gather information and verify patient benefits to determine clearance for pediatric services.
  • Verified documents and associated records to catch and resolve discrepancies.
  • Developed productive working relationships with numerous insurance company representatives.
  • Collected and analyzed referral data and tallied number of referrals.
  • Prepared reports to provide responses to specific problems.
  • Answered questions and resolved concerns raised by both patients and specialists.
  • Identified and resolved inconsistencies in patient responses by means of appropriate questioning or explanation.
  • Prioritized referrals according to urgency and adhered to appropriate referral deadlines.
  • Compiled, recorded, or coded data from referrals or surveys using computer or specified form.
  • Reviewed demographic, clinical and insurance information before sending to referred specialists.
  • Reviewed data obtained from referring physicians for completeness and accuracy.
  • Reviewed referral details and expectations with providers and patients and requested new referrals when necessary.
  • Performed additional office duties, handling patient service inquiries and receiving payments.
  • Assisted referred patients in filling out applications and insurance forms.
Business Analyst, 04/2016 to Current
Aramark Corp.Morehead, KY,
  • I posted payments for patient, All insurance and online payments.
  • Scrub medical claims for over 5 doctors each doctor are very high volume
  • Post Blue Cross an Medicaid remittance
  • Post Paper remittances manually
  • Work patient credits
  • Counseling patient about balances an making payments arrangement
  • Consulting private patient how to get Medicaid.
  • Balancing end of day clinic money
  • Scheduling patient for sick, well visit.
  • Time Management
  • Leadership
  • Teamwork is vital to the success
  • Multi-tasking aided in Communication about different aspects that came from the call center an Front desk
  • Organization skills help stressful situations
  • Interpreting Skills aid in conflict resolution
  • Identified and analyzed user requirements, procedures and processes to develop optimization strategies.
  • Recommended improvements to existing or proposed systems to enhance solution functionality.
  • Participated in valuation and pricing of contracts and services, collaborating with others to incorporate estimates of hourly wages and cost of production expenditures in the provision of services.
  • Participated in valuation and pricing of contracts and services, collaborating with [Job title] to incorporate estimates of hourly wages and cost of product expenditures in provision of services.
New York & Company , 04/2015 to 04/2016
Us Oncology, Inc.Eugene, OR,
  • Customer service
  • Patience
  • Attention to detail
  • Resolution skills
  • Conflict solving
Insurance Verification Specialist, 05/2004 to 09/2009
Montclair Hospital Medical CenterCity, STATE,
  • Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
  • Verified that patients had proper insurance coverage prior to procedures or appointment scheduling.
  • Updated patient and insurance data and input changes into company computer system.
  • Checked documentation for appropriate coding, catching errors and making revisions.
  • Instructed clients on amounts covered under benefits plans in easy-to-understand terminology.
  • Contacted patients to arrange payment arrangements for deductible and out-of-pocket liability.
  • Accessed third-party insurance databases to identify coverage of benefits.
  • Contacted patients to confirm demographic information and communicate financial responsibilities.
  • Entered data in EMR database to record payer, authorization requirements and coverage limitations.
  • Retained strong medical terminology understanding in effort to better comprehend procedures.
  • Handled billing related activities focused on medical specialties.
  • Performed verification of Medicare coverage.
  • Pulled patient files and forwarded to appropriate offices for processing.
Education and Training
Associate of Arts: Health Administration, Expected in 09/1990
Jefferson Community College - Birmingham, AL,
GPA:
High School Diploma: , Expected in 06/1988
Bank’s High - Birmingham, AL,
GPA:

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Resume Overview

School Attended

  • Jefferson Community College
  • Bank’s High

Job Titles Held:

  • Referral Specialist
  • Business Analyst
  • New York & Company
  • Insurance Verification Specialist

Degrees

  • Associate of Arts
  • High School Diploma

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