- Featured in:
Additional Medical Resume Samples
Referral Specialist Resume Samples
No results found
0-5 years of experience
- 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
0-5 years of experience
- 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
0-5 years of experience
- 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.
0-5 years of experience
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
0-5 years of experience
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
0-5 years of experience
- 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
0-5 years of experience
- 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
0-5 years of experience
- 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.
0-5 years of experience
- 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.
10+ years of experience
- 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.
0-5 years of experience
- Receiving new patient referrals
- Created solid relationships with doctor's offices to ensure first referral preference
- Established processes for referrals to be scheduled as soon as possible, sometimes making patient appointments for the next day and notifying provider of the speed of patients appointment.
- Prepare and submit insurance precertification paperwork for injections/procedures.
- Increased submission volume by contacting insurance companies to get online documents, eliminating hand-writing documents, speeding up submission processes.
- Set a high standard of preferred customer service with regard to patients and families, creating strong relationships and a warm and welcoming level of trust and communication.
0-5 years of experience
- Developed Referral Standardization for department workflow, including documentation and policy
- Obtain authorization and benefit information for 3000-4000 internal and external referrals monthly for Primary and Specialty care services to include Consult, Diagnostics and Procedures
- Created and responsible for daily maintenance of internal insurance matrix
- Referral Team Member Training
- Notification of upcoming insurance company changes tor Referral Team
0-5 years of experience
Enter authorizations received from hospitals throughout the valley for members with healthnet/ambetter or Medicare coverage.
- Check members eligibility status, providers and physical therapist contract rates making sure they are par with healthnet/ambetter
- Approve Maternity and various types of therapy authorizations.
- Batch all incoming faxes to the proper UMC
0-5 years of experience
- Provide support to a clinical team to facilitate the administrative components of clinical referrals for various AIM services, and acts as a liaison between hospital, health plans, physicians, patients, vendors and other referral sources
- Initiates and manages clinical referrals for pre-authorization
- Reviews referrals for completeness and follows up for additional information if necessary
- Verifies insurance coverage and completes pre-authorization process for high tech radiology procedures and other imaging exams (CT, MRI, MRA, PET, etc.)
- Contacts physician offices as needed to obtain demographic information or related data
0-5 years of experience
- Responds to inbound calls initiating exam requests following established processes, meets quality and production standards.
- Initiates and manages clinical referrals for pre-authorization.
- Acts as a liaison between hospital, health plans, physicians, patients, vendors and other referral sources.
- Reviews referrals for completeness and follows up for additional information if necessary.
- Assigns escalated referrals to staff as appropriate.
- Verifies insurance coverage and completes pre-authorization process for radiology and other imaging exams (CT, MRI, MRA, PET, et.) following established process and procedures.
0-5 years of experience
- Managed new patient's accounts
- Worked in a team environment
- Managed daily reports and informed colleagues of work to be done
- Trained new employees in the department and acted as an information resource for others
- Complied with HIPAA guidelines
- Took in patient information from many sources and processed efficiently and effectively
- Used Noble House DME software, Salesforce, and Microsoft office
0-5 years of experience
- Take calls from providers to submit and check the status of prior authorization requests while following HIPAA guidelines
- Correct and resubmit faxed authorization requests in order to be reviewed.
- Locate and attach medical records to requests as well as notify nursing staff of the available information for a more immediate resolution.
- Use tools such as Sales Force, CRM, TRUCARE and other applied problem-solving skills to assist with resolving providers' needs.
0-5 years of experience
- Provide perfect service and one on one member interactions.
- Process, contact, and enroll referred members via outbound calls.
- Document per protocol and communicate pertinent information to describe member's medical needs.
- Refer unresolved customer grievances to designated departments for further investigation.
- Meet or exceed referral activity weekly goals.
- Work collaboratively with other team members and build trust.
- Complete extensive research methodology to identify and enroll currently unmanaged members.
0-5 years of experience
- Obtain, faxed/mailed and notified both patient and approved facility of authorizations and referrals through patient insurance or primary care physicians office.
- Update patients insurance in company system.
- Updated patients demographics.
- Notified patients of authorization approvals
- Handled incoming and outgoing calls
- Created letter of appeals for all denials
- Updated cpt/hcpc codes in patients chart
- Updated approvals/denials in patients chart
- Obtained and scheduled patients appointments for the following: Radiology, labs, physical/occupational/speech/feeding therapy, sleep study, breath test, remicade, all durable medical equipments (ie. Formula, feeding pump, wheel chairs, braces, etc.), and follow up with physician.
0-5 years of experience
- Conduct clinical intake interview with potential clients to determine eligibility for psychiatric services using DSM-V criteria.
- Determine the least restrictive intervention based on criteria including acute and chronic risk factors, protective factors, and available resources.
- Provide community referrals when necessary.
- Work with psychiatric teams to facilitate transfers of patients from referring hospitals and organizations.
- Place clients who require inpatient hospitalization, partial hospitalization, or intensive outpatient treatment in an appropriate program either within Ingalls hospital or another facility within their insurance providers network.
- Coordinated with insurance/case management offices for approval of care reimbursements for clients.
0-5 years of experience
Coordinate outreach events and build relationships with community agencies and corporations to support parents and providers citywide
- Coordinate, develop, and conduct bilingual trainings and workshops for parents and Family Child Care Providers
- Create informational resource packets for parents and providers
- Provide technical assistance to Family Child Care Providers
0-5 years of experience
- Monitor utilization of medical services to assure cost-effective use of medical resources through processing prior authorizations
- Initiate authorization requests for outpatient and inpatient services in accordance with the prior authorization list
- Route to appropriate staff for follow up processing as needed
- Verify eligibility and benefits
- Answer phone queues and process faxes within established standards
- Data entry of authorizations into system
- Ability to successfully obtain missing information from providers
0-5 years of experience
- Responds to inbound calls initiating exam requests following established processes, meets quality and production standards. Data entry processes, entering member information into system.
- Initiates and manages clinical referrals for pre-authorization.
- Acts as a liaison between hospital, health plans, physicians, patients, vendors and other referral sources.
- Reviews referrals for completeness and follows up for additional information if necessary.
- Assigns escalated referrals to staff as appropriate.
- Verifies insurance coverage and completes pre-authorization process for radiology and other imaging exams (CT, MRI, MRA, PET, et.) following established process and procedures.
- RBM IMASIS system
0-5 years of experience
- Answer phones, schedule patient apptointments and direct calls
- BCN and UHC Referrals
- Precertification for patient procedures such as MRI, CT SCAN, 2D ECHOS, STRESS TEST, ETC.
- Prior Authorizations for patient medication
- Handle Sleep Study forms and CPAP forms
0-5 years of experience
- Initiate authorization requests for outpatient and inpatient services in accordance with the prior authorization list. Route to appropriate staff when needed.
- Verify eligibility and benefits.
- Answer phone queues and process faxes within established standards.
- Data enter authorizations into the system.
- Process Check Run and Pend Report
- Transitioned seamlessly into my new role as a Referral Specialist.
- Consistently met compliance audits at expected standards.
- Individual audits have exceeded the 90% expectation from onset.
0-5 years of experience
- Process outgoing referrals to internal and external specialty offices.
- Maintain patients insurance coverages to assure accuracy.
- Answer incoming calls from patients requesting new referrals and/or referral questions.
- Accountable for maintaining accuracy and completeness of patient's insurance coverage.
0-5 years of experience
- Process referrals using ICD10 codes, CPT codes and following CMS guidelines
- Assist patients phone inquires of referrals status and aid in obtaining appointments with specialist based on insurance coverage.
- Utilize E-clinical works, Datalink, Avality and GCX software to obtain authorizations
10+ years of experience
- Train new referral specialists, provide Referral Center orientation for new employees
- Assist patients, families, caregivers, case managers and doctors with processing new referrals for [company name].
- Data entry of new patient information to EMR
- Schedule Admission RN's for patient assessment visits
- Back up to Administrative Assistant for entry of Physician Licensure and resources
- Verification of insurance benefits and certification periods
0-5 years of experience
- Make outbound calls to providers to gather required information for referrals
- Enter notifications, Providers status of an existing notification and determining if notification is required
- Complete notification wizard along with ICD-9 and CPT coding.
- Assist with faxes and emails, emails and letters to the beneficiaries, providers and the MTFs (Military Treatment Facility)
- Also to generate approval letters and send them to the correct recipient
0-5 years of experience
- Processing intake/ongoing applications approval/denial for Medicaid, SNAP and OWF.
- Conduct telephone interviews for SNAP and OWF.
- Research county notifications via Work Number and Iris Imaging upon income change in case.
- Manage a caseload of 80 plus cases on a weekly basis.
- Act as a liaison for clients via front desk to communicate with and intake necessary documents.
- Educate clients on additional available resources in the community based on their needs.
0-5 years of experience
- Initiate telephonic outreach to members identified by [company name] at Home as viable candidates for Care Management and Engagement.
- Explain [company name]'s Care Management program and obtain consent for enrollment.
- Document per protocol and communicate pertinent information to designated person and/ or persons.
- Meet or exceed referral activity goals on a weekly basis.
- Participate in the promotion of the multi-disciplinary healthcare team.
- Work collaboratively with other members of the clinical leadership team.
- Relate to a production environment and understand process flows.
- Additional responsibilities as deemed appropriate by [company name] At Home Leadership.
6-10 years of experience
- Create new referrals
- Document data entry of referral authorizations
- Ensure patient privacy and confidentiality
- Prepared medical charts and records for referral patient visits
- Schedule new patient appointments
- Set up and uphold manual and automated information filing systems
0-5 years of experience
- Organizes and ensures timely intake procedures on referrals
- Acts as a liaison between clients, clinicians, and medical staff
- Tracks referrals, admissions, and monitor timelines for adherence to state guidelines
- Secures residential approval for clients in collaboration with the residential manager
- Interviews clients, reviews records, and confer with other professionals to evaluate individuals
- Initiates the pre-certification processes for clients in the mental health, residential, and outpatient programs
- Coordinates referral activities with courts, probation officers, community services, or other pre-treatment agencies regarding pending clients.
0-5 years of experience
Responsible for administrative duties in an Internal Medicine and Infectious Disease Medical Office.
- Scheduling appointments
- Greeting patients/Answer telephones
- Insurance referrals
- Proficient with ECW software
- Medical Office duties
0-5 years of experience
- Review clinical intakes
- Identify clients' needs and match the appropriate provider with client using proprietary database
- Enter provider information into database management system
- Maintain strict confidentiality of clients' information
- Communicate provider information to clients
- Proactively manage caseload
- Any other delegated responsibilities and specially assigned duties, as management deems necessary
0-5 years of experience
- Obtain physician approval for referrals to specialist and diagnostic procedures
- Utilize third party payer/insurance portals
- Follow up with the insurance company regarding the status of the authorization.
- Scan and upload referrals and authorizations to patients file through Epic
- Organize and prioritize my workload
- Complete referral in a timely manner, Fax referrals to the specialists
0-5 years of experience
- Initiates and manages clinical referrals for pre-authorization.
- Acts as a liaison between hospital, health plans, physicians, patients, vendors and other referral sources.
- Reviews referrals for completeness and follows up for additional information if necessary.
- Assigns escalated referrals to staff as appropriate.
- Verifies insurance coverage and completes pre-authorization process for radiology and other imaging exams (CT, MRI, MRA, PET, et.) following established process and procedures.
- Responds to inbound calls initiating exam requests following established processes, meets quality and production standards.
- Contacts physician offices as needed to obtain demographic information or related data.
- Enters referrals, documents communications and actions in system.
0-5 years of experience
- Review prior authorizations for inpatient and outpatient services medical and behavioral health
- Contact providers for clinical information required for approval of authorization
- Update authorization using CareConnect software
- Perform eligibility search
- HIPPA compliance
0-5 years of experience
- Initiate authorization requests for outpatient and inpatient services in accordance with the prior authorization list. Route to appropriate staff when needed.
- Verify eligibility and benefits
- Answer phone queues and process faxes within established standards
- Data enters authorizations into the system.
0-5 years of experience
- Referred Delinquent Conventional Mobile home, FHA home, and FNMA home loans to foreclosure.
- Handle all required call volumes, and maintain delinquency rates within industry
- Frequent contact with foreclosing attorneys to ensure state guidelines and regulation
- Occasionally train junior staff members
- Provide guidance foreclosure specialists
- Interact with other default departments to ensure compliance to Federal, state and local laws and requirements.
0-5 years of experience
- Provide administrative support to the Executive Director, Client Services Manager, and case managers
- Conduct intake interviews to determine client eligibility for services
- Provide callers with information about and referrals to various community resources
- Create and publish monthly newsletters for the Nutrition Services Department
- Manage the Mobility Equipment Donation program
- Assist clients with Medicaid applications
0-5 years of experience
- Works with the member management team to effectively initiate authorization requests for outpatient and inpatient services
- Effectively manage work related queues with accuracy, speed, calmness, and curtesy
- Answer inbound phone calls and process faxes within established standards
- Meticulous attention to detail in review for precision and completion of authorization forms
- Verify member’s insurance eligibility and benefits according to HIPPA guidelines
- Data entry of authorizations into the state Medicaid computer systems (GAMMIS, Amisys etc.)
- Routes providers and members to appropriate departments as necessary
- Provide CPT and ICD code requirements to providers
0-5 years of experience
- Confirm that providers in are network, for referral
- Verify correct insurance information
- Confirm Authorization number
- Call patient to inform of appointment date and time
- Help establish relationship among in network providers
- Follow up on patient appointment date and time
- Fax, scan patient documentation and insurance, labs, diagnostics, etc.
0-5 years of experience
- Check accounts for delinquency and investor guidelines
- Prepare and Mail demands first class and certified mail
- Document all correspondence with mortagors
- Prepare loan documents and refer to the attorney
- Excel, Word, Tempo
0-5 years of experience
- Primarily performed tasks telephonically
- Obtained information from callers to assess their needs
- Provide available resources to callers based on a brief assessment
- Participate in multiple fundraising events