Referral Specialist Ii resume example with 11 years of experience

Jessica Claire
Montgomery Street, San Francisco, CA 94105 (555) 432-1000,
Professional Summary

A quick learner and meticulous artificer with 10 years of experience in various types of administrative and clerical support. Fantastic attention to detail, collaboration skills and typing ability. Committed to streamlining organizational procedures to optimize office settings and promote project realization.

  • Multi-line telephone operation
  • Proficient MS office
  • Analytical and critical thinking
  • Computer proficiency
  • 65 WPM typing
  • Customer service optimization
  • Motivational Interviewing
  • Calm disposition
  • Strong public speaker
  • Strong interpersonal , verbal and written communication
  • Due Diligence
Work History
07/2019 to Current Referral Specialist II Centene Corporation | New Port Richey, FL,
  • Fostered excellence by example by "setting pace" and being hands on mentor to peers and inter-departmental staff.
  • Maintained accurate records on in-progress and completed departmental projects, ensuring full data integrity throughout process for 5 monthly high volume reports.
  • Built professional relationships with service providers.
  • Worked with member advocates to obtain authorization for Long Term Care supportive services.
  • Partnered with other departmental teams and leadership to provide top-notch service to member advocates.
  • Collected and verified completeness of required intake forms for clinical review and coordinated receipt of missing documentation.
  • Worked with Delegated group contacts and internal contracting management to obtain prior authorization and service financial agreements for services to be rendered.
  • Verified insurance benefits and eligibility for procedures prior to authorizing services.
  • Assisted clinical and non clinical staff with troubleshooting and problem resolution.
  • Answered phone calls and messages from member advocates at medical facilities regarding but not limited to authorization intake, status, eligibility, county procedures, scheduling appointments and coordinating clinical reviews, upwards of 10 calls per hour.
  • Assisted member advocates in locating resources for services not handled within department.
  • Trained team of 10 on referral and intake process.
  • Trained staff on answering telephone calls regarding; intake process, answering questions, identifying financial risk types and directing calls to alternate departments.
  • Implemented updated worksheet sorting for digitizing and streamlining monthly departmental projects.
  • Acted as subject matter preceptor for operating systems and work processes to clinical, non clinical and leadership staff.
  • Executed monthly staff audits for quality and accuracy according to departmental standards and deadlines.
  • Created and maintained electronic job aids and FAQ reference documents to support current and new onboarding staff for day to day functions.
  • Comprised and prepared production reporting for Supervisor review.
  • Participate in inter-departmental work groups to establish staff competencies for corporate review and implementation.
  • Received and provided cross training for inter-departmental work process support.
  • Coordinated daily work assignments and managed individual staff work volume to ensure work was completed per compliance standards for team of 10.
  • Interviewed and trained staffed.
  • Maintained team web page of department SharePoint per departmental standards.
09/2010 to 07/2020 Records Manager Escambia County Sheriff's Office | Pensacola, FL,
  • Received and categorized incoming records and filing requests to begin document processing sequence while completing backlog of 2,000+ records.
  • Scanned paper documents into computer and assigned identification numbers to simplify tracking process.
  • Organize hard and electronic copy filing cabinets.
  • Adhered to established procedures for handling sensitive and classified documents to retain privacy law integrity.
  • Forwarded documents requiring additional review to Billing Analysts to obtain instructions for subsequent document resolution.
  • Coordinated secure disposal of sensitive documentation and records.
  • Distributed completed document packages to Data Analysts for final project coordination.
  • Documented all work hours dedicated to research and processing of document requests.
  • Maintained legally compliant, highly secure and user-friendly content to facilitate smooth use by internal and external stakeholders.
05/2015 to 07/2019 Utilization Management Coordinator I Altamed | Garden Grove, CA,
  • Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
  • Performed prior authorization review of services requiring notification.
  • Collaborate with team on solutions for irregular requests and issues.
  • Direct day-to-day administrative and operational assistance providing guidance and clarification to stakeholders and member advocates regarding service authorizations.
  • Collaborated with team Lead and Supervisor to maintain daily operations for remote team.
  • Motivated and supervised 3 additional Utilization Management Coordinators in delivering quality customer experience and project management.
  • Managed day to day Census reports.
Expected in 06/2013 Associate of Arts | Visual Communication Fashion Institute of Design And Merchandising, Los Angeles, CA, GPA:

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Resume Overview

School Attended

  • Fashion Institute of Design And Merchandising

Job Titles Held:

  • Referral Specialist II
  • Records Manager
  • Utilization Management Coordinator I


  • Associate of Arts

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