Referral Specialist Resume Sample
Tracey DuBuque
31454 Bauch Pines,
Detroit,
MI
+1 (555) 594 9579
Work Experience
Referral Specialist
04/2016
-
PRESENT
San Francisco, CA
- Remind patients of scheduled appointments via mail or phone
- Assist patients in problem solving potential issues related to the health care system, financial or social barriers (e.g., request interpreters as appropriate, transportation services or prescription assistance). Identify and utilize cultural and community resources
- Contact review organizations and insurance companies to ensure prior approval requirements are met
- Demonstrate respect for the privacy and confidentiality of patient’s protected health information
- Knowledge of clinic referral and scheduling processes and billing/authorization requirements
- Knowledge of federal and state pay requirements, including Medicare, DSHS, HMO/PPO Contracts
- Communicate effectively and to maintain strict confidentiality
Information & Referral Specialist
07/2009
-
10/2015
Houston, TX
- Respond to people and issues promptly and appropriately to resolve problems
- Actively demonstrates the organization’s mission and core values, and conducts oneself at all times in a manner consistent with these values
- Knows and adheres to all laws and regulations pertaining to patient health, safety and medical information
- Knowledgeable of third party payor policies and procedures, documentation requirements, and patient instruction procedures
- Coordinates with other departments as needed to facilitate patient’s visit
- Provides the primary telephone customer service presence for Affilia’s home health services. Manages all incoming calls to Central Intake and ensures a timely response
- Responds effectively, positively and professionally to all phone calls, electronic transmissions, e-mails and faxes with a strong commitment to service orientation at all times
- Identifies objections, concerns or other entry barriers and provides information in response to address those issues. Proactively offers alternatives if Affilia is unable to provide services
Assessment / Referral Specialist
12/2004
-
02/2009
Detroit, MI
- Initiates referral documentation of a pre-determined set of data elements from all referral sources and determines the appropriate workflow based on the complexity of the referral. Follows up with referral sources for clarification and/or additional information when needed
- Ensures consistent and timely initial communication regarding referrals occurs between Central Intake and agency Branch offices or service lines
- Serves as agency representative in communicating information related to agency services, policies, billing, etc. to patients, families, and referral sources
- Processes and documents referrals that are not accepted for admission including the specific reason for non-acceptance according to agency protocols
- Maintains positive professional relations with agency personnel through appropriate and timely responses for information or paperwork necessary for key clinical and billing functions
- Appropriately utilizes Central Intake Nurse and/or Manager for outliers, problems or difficulties
- The Mental Health Therapist coordinates communication related to all assessment and admission activities, insures rapid throughput for the emergency department, requests additional resources when needed based on volume, and works with the medical staff to move patients to disposition quickly
- The Mental Health Therapist works collaboratively with behavioral health sales team to provide data, assure accurate referral data management, and includes sales team members in team meeting
- The Assessment/Referral Specailist coordinates communication related to all assessment and admission activities, insures rapid throughput for the emergency department, requests additional resources when needed based on volume, and works with the medical staff to move patients to disposition quickly
Education
University of Sioux Falls
2000 - 2004
School's Degree in Psychology
Professional Skills
- Excellent communication skills - both verbal and non-verbal
- Excellent interpersonal skills - adaptable, flexible, responsive, respectful and mature
- Begin on-line process of above, utilizing skills of typing, medical terminology, and ICD/CPT coding
- Demonstrates effective time management and is proactive in prioritizing workload and meeting productivityrequirements.
- Effective problem-solving, planning, and organizational skills
- The ability to work independently, have a great attention to detail, and utilize critical thinking skills are required
- Experience in healthcare setting or a combination of customer service and healthcare experience
How to write Referral Specialist Resume
Referral Specialist role is responsible for medical, computer, coding, training, health, typing, finance, credit, database, procurement.
To write great resume for referral specialist job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Referral Specialist Resume
The section contact information is important in your referral specialist resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:
- First and last name
- Telephone number
Work Experience in Your Referral Specialist Resume
The section work experience is an essential part of your referral specialist resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous referral specialist responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular referral specialist position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Referral Specialist resume experience can include:
- The Assessment/Referral Specailist works collaboratively with behavioral health sales team to provide data, assure accurate referral data management, and includes sales team members in team meeting
- Strong organizational skills and the abilities to prioritize work and manage time
- Excellent customer-service and telephone skills required
- Excellent interpersonal communication and telephone skills required
- Excellent customer service skills and be able to communicate well
- Communicates effectively with all internal and external customers – PCP, Patient, clinical departments, etc. in order to obtain the
Education on a Referral Specialist Resume
Make sure to make education a priority on your referral specialist resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your referral specialist experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.
Additional details to include:
- School you graduated from
- Major/ minor
- Year of graduation
- Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.
Professional Skills in Referral Specialist Resume
When listing skills on your referral specialist resume, remember always to be honest about your level of ability. Include the Skills section after experience.
Present the most important skills in your resume, there's a list of typical referral specialist skills:
- Medical terminology, ICD and CPT coding skills required
- Computer knowledge and typing skills required
- Knowledge and ability to effectively and accurately use ICD-9, ICD-10 and CPT coding
- Prior experience in a call center environment required
- Clerical and computer skills required
- Four years experience in a clinical setting or displays competency in standard nursing procedures
List of Typical Experience For a Referral Specialist Resume
1
Experience For Information & Referral Specialist Resume
- Excellent communication and interpersonal skills with the ability to communicate clearly in person and on the phone
- Work effectively as a team member and provide assistance to other staff members willingly
- Hospital clinical experience working with physicians, social workers, case managers and various levels of hospital personnel
- Six months experience in a psychiatric setting with direct patient contact
- Identifies insurance companies requiring prior authorization for services and obtains authorization
- Prioritizes and organizes workflow meeting productivity goals of the section
- Certified Nurse's Assistant (CNA), Medical Assistant (MA), or equivalent in training and work experience
- Performs function with accuracy and effectiveness. Work reflects professionalism and quality product
- Work alternative schedules and demonstrate flexibility in times of disaster
2
Experience For Pathology Referral Specialist Resume
- One year of experience in a similar position in a medical office
- Initiate authorization requests for outpatient and inpatient services in accordance with the prior authorization list. Route to appropriate staff when needed
- Mortgage default related experience
- Experience in a high-volume, interactive customer service or call center environment
- Good computer keyboard proficiency
3
Experience For Assessment / Referral Specialist Resume
- Call Center and Customer Service experience
- Experience in a hospital or physician office with a background in medical terminology and insurance
- Verifying in-network/out-of-network insurance benefits and obtaining authorizations for referrals and testing
- Using internal scripts, process auto-approve requests per department procedures
- Providing backup coverage for Staff Support Assistant
- Working knowledge of managed care philosophy and familiarity with acronyms
- Working Knowledge of Medical terminology and CPT background
4
Experience For Assessment & Referral Specialist Resume
- Communicates with the scheduling department to verify each patient’s insurance requirements have been satisfied for upcoming
- Coordinates the scheduling of appointments for specialty provider appointments and related diagnostic testing/procedures
- Completes registration and obtains insurance authorization for new patients, diagnostic testing and for hospital admissions
- Updates patient insurance information in billing systems as needed
- Acts as an educational resource for patients and parents regarding payer rules
- Assist with precepting new associates
5
Experience For CEA Referral Specialist Resume
- Certified Nursing Assistant or Medical Assistant certification
- An in-depth understanding of electronic medical record systems, with the ability to extract relevant cardiac history, complaints, and concerns
- Schedules and/or coordinates the scheduling and authorizations for provider pre-planned in office procedures ordered by assigned specialty(ies)
- Accepts initial inquiries from referring facilities and clinically assesses the referred patient to insure appropriateness for admission to Bethesda Hospital
- Increases census growth through education and relationship building with providers
- Communicates and responds to customer needs in a professional, positive manner building credibility and rapport with all contacts
6
Experience For Resource / Referral Specialist Resume
- Assist in maintaining files for department
- Work a flexible work schedule including evenings and weekends
- Participates in Provider Education regarding Health Services policies and procedures
- Handles lost/retroactive referrals to help eliminate billing problems for patients, insurance companies, and PCP's
- Respond to calls and provide appropriate referrals using the resources available through Alaska 2-1-1 database
7
Experience For Physician Authorization / Referral Specialist Resume
- Has a thorough understanding of process and performs requests in a timely fashion
- Provide patient/provider/team education regarding insurance policy coverage and limitations
- Maintains neat, accurate and complete records according to established policies and procedures
- Responsible for providing support to a clinical team in order to facilitate the administrative components of clinical referrals for various AIM services
- Current unencumbered California Licensed Vocational Nursing or current unencumbered California Registered Nurse licensure
8
Experience For Referral Specialist / Ummc Fayette Clinic Resume
- Performs software Functions Accurately while telemarketing
- Ensures financial information and insurance has been verified
- Initiates the referral and authorization process for all services and visits
- Provides patient with referral information for other physicians and facilities
- Analyzes information required to complete pre- authorizations with insurance carriers and governmental payors
- Contacts various clinics, facilities, companies to obtain information to accurately complete referral/pre authorization requests
9
Experience For Ins Auth / Referral Specialist Resume
- Utilizes third party payer/insurance portals; has a detailed knowledge of insurance providers, their portals and their expectations for authorization approval
- Provides the primary telephone customer service presence for Affilia’s home health services
- Attend and actively participate in department and organizational committees
- Collaborate with team in development of reliable methods and workflow improvements
- Communicates with ordering providers and nursing regarding insurance authorizations, denials, peer-to-peer review requests and scheduling difficulties with referrals to providers
- Takes telephone requests for authorizations. Prepares referral requests. Informs patients of appointment information and instructions
10
Experience For Prior Authorization / Referral Specialist Resume
- Maintains electronic health record (EHR) referral documentation to reflect actions on specific referrals (including adding incoming referrals that were not generated from the electronic health record (HER)). Maintains referral resource document
- Schedules referral appointments with appropriate department or referred to provider. Tracks referral patient compliance and communicate with referring provider as necessary regarding patients refusing service and patients not showing up to a referral appointment
- Submits retroactive authorization requests as needed
- Work closely with physicians, mid-levels, and RNs
- Proficient with EPIC, Microsoft Excel, iCentra, Powerchart, and Microsoft Word
- Schedules and/or coordinates the scheduling of appointments for incoming referrals to assigned specialty physician services and/or diagnostic testing per provider request and communicates with the patient on a timely basis for all scheduling requirements
- Acts as a liaison between patients, providers, departments and staff members for patients referral and follow up needs. Provides prompt and professional service for the patients by assisting in educating patient/family and assisting patients with external resources when needed
List of Typical Skills For a Referral Specialist Resume
1
Skills For Information & Referral Specialist Resume
- Effectively utilizes resources available to minimize errors.
- Adapts to rapidly changing technologies, policies, regulations, census and staffing through priority setting andflexibility.
- Two years of experience providing customer service in a healthcare setting is required
- Experience required in any of the following: admissions, physician office, billing company or insurance company. Medical Terminology required
- Serve as a Duke Health Ambassador by providing a comprehensive access experience including helpful resources, information, and accurate answers to questions
- Experience in a Business Office or related setting
- Establish and maintain effective working relationships with patients, medical staff, and co-workers
- Experience in computer scheduling and word
- Three years of medical office referral experience required. Medical terminology, CPT/ICD-9/10 coding, knowledge of carrier benefits and guidelines required
2
Skills For Pathology Referral Specialist Resume
- Create a warm, inviting experience for our patients, their loved ones, and each other
- Demonstrate proficiency in using call center software, computer hardware and telephone equipment
- Demonstrated understanding of cardiology and medical terms
- Work independently, self-motivated, and prioritize
- Sets priorities; makes constructive suggestions and thinks proactively; recognize the importance of process and systems. Strives to improve them
- Working knowledge of medical terminology, managed care/insurance industry, and health care reimbursement sources
- Keyboarding at 45 wpm
3
Skills For Assessment / Referral Specialist Resume
- Walking is required throughout the day
- Answering daily phone calls and pages from doctors, patients, employees and insurance companies
- Sit for long periods of time, standing, bending, stooping, stretching for files and supplies, occasional lifting of papers, files, etc. of up to 15 pounds
- Flexible scheduling is available with day, evening and night shift positions all being current options. Shifts range from 8-10 hours
- Proactive in engaging in or seeking out self learning opportunities
4
Skills For Assessment & Referral Specialist Resume
- Constant sitting, use of arms/wrist, manual dexterity (grasping/squeezing), & keyboard operation
- Spends time during the day using computers, telephones and printers
- Responds to inbound calls initiating exam requests following established processes, meets quality and production standards
- Maintains high level of accuracy in all data collection and entry, appropriately following through and documenting the interaction
- Maintains professional standards by participating in orientation,training and seminars
- Proficient in the use of PC applications including word processing, preparation of table, charts and graphs
- Provides primary coverage for Service Center, which includes setting appointments and logging information
- Handles the filing of support documentation regarding physicians/consumers referral request
5
Skills For CEA Referral Specialist Resume
- Assists in identifying and data gathering for potential COB cases
- Verifies PCP has completed referral accurately, tasking provider if any discrepancies or questions before processing
- Notifies patient of scheduled appointments giving them the location and any preparation for the appointment/testing if needed
- Answer calls from office or patients in regards to referrals being processed, helping resolve any issues or concerns with the referral
- Regularly attends staff meetings and is responsible for obtaining information from meeting if unable to attend
6
Skills For Resource / Referral Specialist Resume
- Maintain a nonjudgmental attitude when speaking with callers, displaying sensitivity to all cultural backgrounds
- Assess the callers' needs or situation using pertinent questions and the principles of active listening
- Maintain an acceptable level of call handling and customer service performance as described by the 2-1-1 training standards
- Complete all training for new programs and services related to 2-1-1 and providing feedback as needed
- There is a 6 week training program
- Obtain authorization with third party insurance companies for referrals to specialists and diagnostic testing.
- Participates in professional and program development by attending department in-services, and meetings
- Assists with the education and training of staff.
- Adheres to strict work schedule guidelines during hours of operation.
7
Skills For Physician Authorization / Referral Specialist Resume
- Obtain accurate information including all pertinent patient data to include but not limited to insurance verification,precertification numbers, birth date etc.
- Gather, verify, and process referrals, authorizations, and pre-certifications by working closely with physician(s), patients, and payers
- Ensures that accurate medical record information is given regarding the patient and that the pertinent payer information is obtained and correct
- Develop and maintain professional, service-oriented working relationships with patients,physicians, co-workers and supervisors
- General nursing knowledge in Medical/Surgical, Pediatrics, OB/GYN, Psychiatric Health or related clinical areas
- Knowledge of medical terminology, ICD-10, CPT and HCPCS coding required
- Medical terminology and/or anatomy understanding required
- Communicate both verbally and in writing
- Knowledge of managed care and medical office billing procedures
8
Skills For Referral Specialist / Ummc Fayette Clinic Resume
- Medical terminology, and basic understanding of human anatomy
- Attendance - within first 90 days - no more than 2 unplanned time off - anything
- Calls returned in queue - answer the call before the 3rd ring
- Employs a systematic approach in problem solving
- Employs a systematic approach in problem solving; makes decisions based on thoughtful analysis of the situation, and evaluation of the alternatives
- Coordinates the forms inventory, ordering and distribution of forms
9
Skills For Ins Auth / Referral Specialist Resume
- Ensure accurate and timely responses to all referral requests and inquiries regarding SHCN specialty services
- Completes daily referrals and insurance authorizations with understanding and knowledge of medical necessity guidelines for multi-specialty practices
- Obtain daily referrals and insurance authorizations with understanding and knowledge of insurance guidelines for multi-specialty practices
- Processes Overdue Cross Coverage Worklist to ensure referrals are being processed in a timely fashion
- Support other functions of the call center (i.e. prepare mailings, filing, etc.,)
10
Skills For Prior Authorization / Referral Specialist Resume
- Willingness to pursue required credentialing
- Gather, verify, and process orders for test, referrals, authorizations, and pre-certifications by working closely with physician(s), patients, and payers
- Maintains current patient records including current outside physician (Primary Care Physician), phone numbers, fax number and insurance information
- Has a thorough understanding of process and documents/communicates in a timely fashion
- Displays courtesy and professionalism in dealing with City of Hope employees, patients, visitors and customers
- Answer phone call with appropriate tone of voice, paying close attention to voice inflection and volume
- Advocates for patients by helping them navigate through the Carle system
List of Typical Responsibilities For a Referral Specialist Resume
1
Responsibilities For Information & Referral Specialist Resume
- Begin on-line process utilizing skills of typing, medical terminology and ICD/CPT coding
- Experience:Two years of experience providing customer service in a health caresetting is required
- Demonstrates professional telephone technique with strong focus on communication style and knowledge of Duke Medicine to include its partners and affiliates
- Communicates effectively with patient, family, referral sources, insurance companies and throughput team to insure a smooth admission process
- Customer Call Center experience
- Coordinate flow of information between medical clinic and patients insurance for referral authorization to secure a valid referral for clinic patient
- Demonstrates the ability to compose original correspondence that is clear, concise and well researched, without detailed instruction from requestor
- Keeping team members informed of status of requests
2
Responsibilities For Pathology Referral Specialist Resume
- Receives, researches and completes, in a timely manner, all inquiries and requests ensuring optimum customer satisfaction
- Responds to incoming physician/cross-sell/service calls
- Has a thorough understanding or process and distributes paperwork to affected City of Hope Departments in a timely fashion
- As needed, retrieving orders from chart, and request authorization through the insurance companies
- Continually updates knowledge of new techniques and equipment avoiding adverse consequences
- Reviews upcoming provider schedules to ensure all appointments have appropriate referral and authorizations required for anticipated visits and procedures
- Accountable for physician/consumer relations and customer service activities
- Communicates and responds to customer needs in a professional, positive manner building credibility and rapport with all contacts. Customers defined as but not limited to, referring physicians and their staff, patients, consumers, co-workers, Duke faculty and staff, other employees within the health system
- Makes decisions based on thoughtful analysis of the situation, and evaluation of the alternatives
3
Responsibilities For Assessment / Referral Specialist Resume
- Provides documentation as needed
- Maintains customer focus in stressful situations and exercises respect and patient confidentiality at all times
- Responsible for accurate business data collection and maintenance of both the Provider Professional Master (PPM) database and eCentaurus databases
- Utilizes the computer systems IDX, DHIS, and eCentaurus according to departmental protocols to include accurate data entry and retrieval of information for reporting purposes
- Operates and troubleshoots voicemail and telephone system in support of communications provided by DCRC
- Assumes ownership of each transaction
4
Responsibilities For Assessment & Referral Specialist Resume
- Remains current on changes in policies and protocols in DCRC
- Communicates new information related to all clinical services and referral protocols for Duke Hospital,the clinical departments, the Private Diagnostic Clinic, Community Private Diagnostic Clinic, Duke Primary Care, Durham Regional Hospital, Duke Raleigh Hospital, and all other affiliates and entities of Duke Medicine
- Identifies and communicates needs and operational improvements,including technical system changes and updates, to maximize the efficiency and accuracy of services provided by DCRC in an environment of change
- Communicate details information and answers patients’ questions regarding their health care plan; provide answers to billing and insurance clarifications questions
- Maintain direct address’ to send referrals electronically utilizing the system, as appropriate
- Field patient phone calls: pricing quotes, information about pain program, insurance coverage questions (from existing and potential new patients), calls from QRC’s, claims adjusters, etc
5
Responsibilities For CEA Referral Specialist Resume
- Initiate authorization requests for outpatient and inpatient services in accordance with the prior authorization list -route to appropriate staff when needed
- Answer phone queues and process faxes within established standards
- Data enters authorizations into the system
- Communicate via the RELATE communication model, work for a resolution, own service recovery, and use communication skills to build trust, respect, and a sense of confidentiality
- Technically navigate protocols, systems, etc
- Express appreciation and adapt behavior and communication styles to meet the individual’s needs
- Enters referrals, documents communications and actions in system
6
Responsibilities For Resource / Referral Specialist Resume
- Enters referrals, documents communications, actions and other data in system
- Provide support to the clinical team in order to facilitate all administrative components
- Act as liason between hospitals, physicians, vendors, and patients
- Initiate and manage referrals for pre-authorization and reviews referrals for completeness
- Verify insurance coverage and obtain authorizations as needed from insurance plans
7
Responsibilities For Physician Authorization / Referral Specialist Resume
- $14 - $16 per hour
- Identifies education needs in each account and implements account education plans
- Function under stressful situations and meet deadlines
- Able to navigate the Electronic Medical Record
- Familiarity with the DSM IV
- Customers defined as but not limited to, referring physicians and their staff,patients, consumers,co-workers, Duke faculty and staff, other employees within the health system
8
Responsibilities For Referral Specialist / Ummc Fayette Clinic Resume
- Provides documentation as needed.Maintains customer focus in stressful situations and exercises respect and patient confidentiality at all times
- Responsible for accurate business data collection and maintenance of both the Provider Professional Master(PPM) database and eCentaurus databases
- Utilizes the computer systems Maestro Care, DHIS, and eCentaurus according to departmental protocols to include accurate data entry and retrieval of information for reporting purposes
- Assists and responds to Internet referrals on a daily basis for both the hospital and the CMC facility as well as the Phone 1. Health Internet referrals
- Assists with the development and management of promotional programs for various services
- Coordinates with international patients and their family members with hotel reservations, travel arrangements and transportation needs
- Assists with preparation of monthly and quarterly reports of referral program utilization and results of marketing programs. Prepare charts, graphs or files as requested
- Updates provider profiles and department directory of insurance provider contacts
- Assists with verification of update of provider profiles and department directory of insurance provider contacts
9
Responsibilities For Ins Auth / Referral Specialist Resume
- Coordinates referrals for the Affiliate/Associate physicians’ patients
- Fast-paced inbound call center environment, 70-80 calls daily
- Verifies insurance coverage and completes pre-authorization process for radiology and other imaging exams (CT, MRI, MRA, PET, et.) following established process and procedures
- $14-16 hourly (based on experience)
- Reviews referrals for completeness and follows up for additional information if necessary
- Eligible for benefits through Randstad
- Ability of request/obtain authorizations/referrals for assigned specialties and be able to cover for most specialties
- Receive, process and complete data entry of demographic information for all referral and authorization requests from providers via fax or phone and as appropriate, forward to precertification nurse/care manager/case manager
- Request, document and forward out of network provider demographic information to PR Department and update case when appropriate
10
Responsibilities For Prior Authorization / Referral Specialist Resume
- Coordinate daily review activity for on-site case managers
- Data entry of daily census, INN emergency room logs, and designated referrals/authorizations per management directive
- Scan electronically attach notes and notify appropriate staff for follow up
- Adhere to URAC, NCQA and other regulator standards
- Communication, Collaboration and Coordination with all customers, internal and external
- Collaborate with and maintain open communication with all other departments as appropriate and required to facilitate completion of tasks/goals
- Attend monthly departmental meetings and/or interdepartmental meetings as appropriate
- Maintains detailed records of information gathered and authorizations issued and extended: this is done by entry into the DST/Health Connect systems
- Responsible for production of authorization letters to providers, members and facilities from the DST system
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