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Supervisor - Referral Services Resume

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Jackson, MS

OBJECTIVE:

Obtaining a position within your company to utilize my education as well as my experience within a corporate environment.

SUMMARY:

  • Formal education in Business Administration with exposure to computer operation and programming
  • 26 years demonstrated effectiveness as a customer service representative
  • 22 years demonstrated effectiveness as an administrative assistant
  • Dedicated to professionalism, highly motivated toward goal achievement

PROFESSIONAL EXPERIENCE:

Confidential, Jackson, MS

Supervisor - Referral Services

Responsibilities:

  • Supervise the day to day operations of the utilization and case management areas
  • Supervise day to day activities of the Referral Services department including work flow, training, hiring, ect.
  • Assist providers, members and/or internal customers with cases pertaining to referral questions, issues and authorizations
  • Reconcile pended claim issues in a timely manner per health plan/department procedure
  • Review and process denial letters, maintain logs and coordinate decisions to external and internal personnel per plan procedures
  • Receive and review incoming phone and case management log reports and determine course of action
  • Work with analysts and programmers in adapting and testing programs and procedures to adhere to our standard operating procedures

Project Coordinator

Confidential

Responsibilities:

  • Track and coordinate projects to ensure prescribed activities are carried out in accordance with specified objectives.
  • Act as a liaison between department and project management software or key project personnel.
  • Coordinate various projects as assigned. Assist in ensuring compliance with departmental policies.
  • Coordinate with key personnel to perform functions as determined by departmental needs.
  • May act as backup to the Administrative Assistant function.
  • Screen for eligibility and benefits.
  • Research claims inquiry specific to the department and the responsibility.
  • Train new employees for the utilization department (prior authorization)
  • Provide technical support to staff and provider ongoing training.
  • Stream line training documents, coordinate department procedures, as well as complete special projects
  • Conduct new hire interviewing

Referral Specialist

Confidential

Responsibilities:

  • Assist in monitoring utilization of medical services to assure cost effective use of medical resources through processing prior authorizations and act as trainer and mentor to less experienced staff.
  • Initiate authorization requests for outpatient 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

Confidential, Jackson, MS

Physician Scheduler

Responsibilities:

  • To coordinate and manage provider schedules to maximize customer service, patient access, provider productivity and business operations.
  • To complete the pre-registration process including using practice management software to track demographics.
  • To make referrals for financial counseling and/ or physician referrals/authorizations/certifications.
  • To verify payment of visits/coordinate all insurance information for payment.
  • Administrative Assistant II, August 2007 - February 2008
  • Schedule all doctor inpatient and outpatient appointments.
  • Administrative assistant duties including doctor dictation.
  • Answer incoming calls while operating a 6-line switchboard phone system.
  • Make all new patient charts and register new patients
  • Insurance verification, Medical office experience

Confidential, Jackson, MS

Assistant to Divisional Secretary

Responsibilities:

  • Insure all divisional vehicles and property.
  • Recruitment of volunteers and resources.
  • Administrative assistant duties. Purchase & control all major purchases of supplies and equipment
  • Process all requisitions and PD5’s.
  • Answer incoming calls while operating a 10-line switchboard phone system.
  • Opening and closing manager when store manager and assistant manager are not in the store.
  • Pulling reports and setting up floor sets.
  • Assisting customers with purchases.

Confidential, Jackson, MS

Senior Membership Specialist

Responsibilities:

  • Promptly and accurately resolve electronic enrollment pend transactions
  • Resolve error identification, research and problem resolution
  • Make logical processing decisions based on knowledge of business processed without routine involvement or assistance from other staff

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