- Featured in:
-
High Quality
The best examples from thousands of real-world resumes
Expert Approved
Handpicked by resume experts based on rigorous standards
Diverse Examples
Tailored for various backgrounds and experience levels
Referral Specialist Resume Samples
Filter:
No results found
Candidate Info
13
years in workforce
4
years at this job
Business Administration
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
6
years in workforce
2
years at this job
BS
Biology
MA
Health Services Management, Thesis
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
4
years in workforce
2
years at this job
BA
Computer Information Systems
MA
Cybersecurity
MA
Managment Infomation Systems Major Business Analytics
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
9
years in workforce
4
years at this job
HS
High School Diploma
C
Auto Mech
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
14
years in workforce
10
months at this job
HS
High School Diploma
Medical Assistant
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
6
years in workforce
3
months at this job
BS
Secondary English Education
Education
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
14
years in workforce
6
months at this job
BA
Counseling / Human Services
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
11
years in workforce
2
years at this job
HS
High School Diploma
AA
Sociology
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
14
years in workforce
4
years at this job
Medical Records Division
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
12
years in workforce
11
years at this job
AS
Business Administration Management
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
16
years in workforce
2
years at this job
AS
Business Administration
BA
Human Resource Management
Referral Specialist
- 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.
Candidate Info
38
years in workforce
5
years at this job
Business Management & Accounting
Referral Specialist- Lead
- 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
Candidate Info
8
years in workforce
8
months at this job
Referral Specialist
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
Candidate Info
13
years in workforce
2
years at this job
HS
Accounting
BA
Business Administration
Referral Specialist
- 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
Candidate Info
12
years in workforce
8
months at this job
HS
High School Diploma
C
Medical Assistant
Referral Specialist
- 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.
Candidate Info
5
years in workforce
3
years at this job
BS
Information Technology
BS
Management
New Referral Specialist
- 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
Candidate Info
13
years in workforce
1
year at this job
BA
Exercise And Health Science
Referral Specialist
- 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.
Candidate Info
13
years in workforce
1
year at this job
GED
GED
AS
Business Management And Accounting
Referral Specialist / Referral Intake Specialist
- 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.
Candidate Info
12
years in workforce
4
years at this job
Referral Specialist
- 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.
Candidate Info
12
years in workforce
5
months at this job
AS
Arts
BA
Psychology
MA
Clinical Psychology
Assessment and Referral Specialist
- 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.
Candidate Info
10
years in workforce
2
years at this job
AS
Social And Behavioral Sciences
BS
Business Management
MS
Human Resource Management
Resource and Referral Specialist
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
Candidate Info
24
years in workforce
2
years at this job
AS
Business Administration
AS
Health Information Technology
Referral Specialist
- 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
Candidate Info
12
years in workforce
8
months at this job
Medical Assisting
Referral Specialist
- 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
Candidate Info
5
years in workforce
1
year at this job
AAS
Medical Assisting
Referral Specialist
- 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
Candidate Info
10
years in workforce
2
years at this job
C
Medical
AA
Associate of Arts
BBA
Bachelor of Business Administration
Referral Specialist I
- 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.
Candidate Info
13
years in workforce
2
years at this job
Medical Terminology
Referral Specialist
- 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.
Candidate Info
12
years in workforce
6
months at this job
AS
Registered Nurse
Referral Specialist
- 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
Candidate Info
16
years in workforce
11
years at this job
N / A
Referral Specialist
- 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
Candidate Info
5
years in workforce
1
year at this job
HS
High School Diploma
HS
Medical Assisting
Referral Specialist Coordinator
- 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
Candidate Info
17
years in workforce
10
months at this job
BA
Sociology
Eligability Referral Specialist
- 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.
Candidate Info
12
years in workforce
2
years at this job
Referral Specialist
- 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.
Candidate Info
12
years in workforce
8
years at this job
HS
Business Administration
Referral Specialist
- 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
Candidate Info
3
years in workforce
8
months at this job
BA
Social Work
Intake and Referral Specialist
- 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.
Candidate Info
28
years in workforce
9
months at this job
AS
Allied Health
Cosmetology
Nursing Sciences
Medical Secretary/referral Specialist
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
Candidate Info
17
years in workforce
3
months at this job
HS
Business Administration
Customer Service/referral Specialist
- 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
Candidate Info
14
years in workforce
1
year at this job
HS
Medical
Referral Specialist - Physician Practice
- 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
Candidate Info
4
years in workforce
4
months at this job
BA
Business Administration
Referral Specialist
- 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.
Candidate Info
5
years in workforce
6
months at this job
BS
Sociology
MA
Healthcare Administration
Referral Specialist
- 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
Candidate Info
15
years in workforce
7
months at this job
Referral Specialist I
- 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.
Candidate Info
16
years in workforce
1
year at this job
AS
Associate of Science
BBA
Organizational Management
Referral Specialist, Green Tree LLC A/k
- 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.
Candidate Info
12
years in workforce
8
months at this job
AAS
Computer Information Systems
BA
Criminal Justice
MA
Public Administration
ADMINISTRATIVE Assistant/information & REFERRAL SPECIALIST
- 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
Candidate Info
9
years in workforce
9
months at this job
BBA
Bachelor of Business Administration
MA
Master of Arts
Referral Specialist
- 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
Candidate Info
13
years in workforce
7
months at this job
AS
Medical Office Administration
Referral Specialist
- 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.
Candidate Info
8
years in workforce
11
months at this job
HS
High School Diploma
Human Resource Management
Referral Specialist
- 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
Candidate Info
8
years in workforce
2
years at this job
BS
Child And Family Studies
Information and Referral Specialist
- 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
Referral Specialist Resume Success Stories
