Referral Specialist Resume Samples

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Referral Specialists work in the healthcare industry and determine if a patient’s insurance allows them to access certain medical services. A well-written resume sample in the field should mention duties like scheduling patient appointments, reporting data, maintaining medical records, retrieving medical records for patient visit, updating referral records, and completing patient authorizations. Based on our collection of resume examples for Referral Specialist, for this job the following qualifications are required: knowledge of insurance procedures and medical terminology, confidentiality, detail orientation, accuracy, computer competences, and teamwork. Healthcare administration training is required in the field.

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1

Referral Specialist

  • Using Athena software helped patients and the practice realize substantial savings
  • Assisted the coordination of care while researching best medical outcomes
  • Obtained prior authorizations and processed referrals for diagnostic services and procedures
  • Established relationships with identified server providers
  • Answered questions from patients, staff, and insurance companies
Candidate Info
13
years in
workforce
4
years
at this job
Business Administration
2

Program Coordinator/referral Specialist

  • Initiated an Emergency Room Diversion project to reduce excessive member ER visits
  • Key resource for processing prior authorization requests in multiple region queues
  • Interpreted medical terminology and pharmacological information for conversion into the coding system
  • Active contributor of the healthcare delivery team, teaching members to take responsibility for their health
  • Maintained integrity of health information in databases and managed written communication; focusing on data
  • Coached/mentored co-workers regarding the daily functions of Medicaid insurance practices
Candidate Info
6
years in
workforce
2
years
at this job
BS
Biology
MA
Health Services Management, Thesis
3

Referral Specialist

  • Performed outbound calls to providers to gather required information.
  • Referred cases as needed for review to pre-authorization nurses.
  • Resolved customer inquiries including, data processing and providing status updates.
  • Ability to work independently and unsupervised maintaining a superior work ethic.
  • Complied with HIPAA Privacy and Security Regulations handling patient information.
  • Prioritized work load and maintained an organized work space.
Candidate Info
4
years in
workforce
2
years
at this job
BA
Computer Information Systems
MA
Managment Infomation Systems Major Business Analytics
MA
Cybersecurity
4

Linkage and Referral Specialist

Conduct HIV counseling, testing and referral (CTR)

  • Distribute condoms to a network of more than 230 locations throughout the city and maintain relationships with all network members
  • Respond to clients' requests for services by assessing need and providing appropriate
  • Maintain records of individuals served, services provided, outreach activities, surveys
Candidate Info
9
years in
workforce
4
years
at this job
HS
High School Diploma
C
Auto Mech
5

Utilization Management Referral Specialist

Assist UM Nurses in completing authorization reviews of specialty services/diagnostics requests in a timely and efficient manner

  • Initiate processing of authorization requests for outpatient and inpatient services, and routing to the appropriate staff
  • Verify eligibility of patient and investigate when patient's eligibility is in question
  • Answer phone queues and process faxes within established standards
  • Coordinate information between UM Nurses and centralized or site scheduling staff
  • Collate daily/monthly reporting information and provide to Statewide Medical Directors, UM Nurses, and Operational leadership, as directed
  • Ensure compliance with all company policies, Federal and State Laws, regulations, and guidelines including HIPAA
Candidate Info
14
years in
workforce
10
months
at this job
HS
High School Diploma
Medical Assistant
6

Information and Referral Specialist

  • Provided information and support to military personnel and their families
  • Provided assistance and support to the FFSC clinicians
  • Trained in and implemented psychological first aid when needed
  • Assisted in maintaining the building
  • Answered multiple phone lines
  • Performed manual data entry
  • Participated in professional development
Candidate Info
6
years in
workforce
3
months
at this job
BS
Secondary English Education
Education
7

Referral Specialist

  • Ensure continuity of care for all members eligable for the [company name] at Home division by referring them for care management servicesto promote health at home
  • Work on an interdisciplinary team while maintaining and exceeding overall weekly goals of processsed referrals
  • Collaboration with other skilled professionals to ensure the needs of each member in the program are addressed and work towards resolution
Candidate Info
14
years in
workforce
6
months
at this job
BA
Counseling / Human Services
8

Referral Specialist

  • Initiate authorization requests for outpatient and inpatient services in accordance with the department guidelines. Route to appropriate staff according to assignment list.
  • Verify eligibility and benefits via MMIS.
  • Answer phone queues and process faxes and approval letters within established standards.
  • Data enters authorizations into the TruCare System.
  • When assigned by management, serve as trainer and mentor to newly hired staff and other employees of Medial Mgmt. dept.
  • Served as the designated Medicare and Ambetter Referral Specialist for PSHP.
Candidate Info
11
years in
workforce
2
years
at this job
HS
High School Diploma
AA
Sociology
9

Referral Specialist

  • Process incoming calls from physician and physician's staff to pre-authorize high tech imaging, sleep studies and related durable medical equipment and radiation therapy
  • Initiate the case based on the information provided by the physician and the clinical guidelines in place per AIM policy
  • Approve the case completely and supply the provider with the complete authorization information
  • If the case does not meet the clinical criteria, then the case is escalated to a registered nurse reviewer or a physician for additional review
  • Work extensively with Blue Cross Blue Shield insurance companies as well as Medicare replacement products
  • Experienced working as the primary outpatient provider for the entire Amerigroup Medicaid System. Other providers that I have worked with include Providence, Assurance, Bridgespan, and Florida Blue.
Candidate Info
14
years in
workforce
4
years
at this job
Medical Records Division
10

Referral Specialist

  • Successfully supported the implementation of Tapestry Utilization Management as a subject matter expert for referrals.
  • Created and executed test cases and validated system results for the Epic Tapestry project.
  • Supported the implementation team in test defect resolution.
  • Created workflows/policies and procedures that were used to train employees on new systems and processes.
  • Performed departmental training for new systems and processes.
  • Assisted members and providers telephonically to resolve issues.
  • Processed referrals within regulated time frames to ensure members received care in a timely fashion.
  • Created time schedules for additional duties that needed to be coordinated between multiple department coworkers.
  • Participated in weekly referrals workgroup meetings.
  • Successfully met all ongoing assigned multiple tasks.
Candidate Info
12
years in
workforce
11
years
at this job
AS
Business Administration Management

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