Bonnie Taft
Portland,Or
Summary
Highly skilled Medical Administrator with expertise in production and project management. Proven ability to deliver immediate results through experience and education. Seeking a similar role to support your company's mission in the most ethical manner, serving your members and providers.
Overview
26
26
years of professional experience
Work History
Referral Specialist
Centene Corporation
Missouri City, MI
03.2019 - 12.2023
- Analyzed trends in denied or delayed referrals and identified opportunities for improvement.
- Processed incoming referral requests for medical services and submitted them to the appropriate insurance companies for authorization.
- Communicated regularly with referring physicians, nurses, case managers, social workers, and other healthcare professionals regarding referral processes and requirements.
- Managed and obtained insurance authorizations for patient referrals from physicians.
- Facilitated communication between primary care physicians, specialists, and patients to ensure a smooth referral process.
- Prepared and distributed referral reports to healthcare management.
- Performed quality assurance checks on completed referrals before submitting them for approval.
- Developed strategies for improving efficiency within the department while maintaining high standards of customer service.
- Participated in staff meetings and provided feedback on ways to improve procedures related to referral processing.
- Tracked progress of each referral throughout its lifecycle from submission through authorization or denial notification.
- Resolved escalated patient complaints relating to denied or delayed referrals promptly.
- Tracked referral request progress and resolved issues to maintain smooth processing.
- Entered confidential patient information and updated electronic records in database.
- Gathered and verified insurance requirements to meet payer requirements.
- Aided clinical team to support administrative needs for clinical referrals.
- Liaised with healthcare facility personnel, insurance representatives, physicians and vendors for smooth communication.
- Prioritized referrals according to urgency and adhered to appropriate referral deadlines.
- Reviewed demographic, clinical and insurance information before sending to referred specialists.
- Answered questions and resolved concerns raised by both patients and specialists.
- Reviewed data obtained from referring physicians for completeness and accuracy.
- Reviewed referral details and expectations with providers requested new referrals when necessary.
- Developed productive working relationships with numerous insurance company representatives.
- Participated in training and professional development opportunities to stay current with best practices in referral coordination.
- Developed and maintained referral networks, establishing strong relationships with a variety of healthcare providers.
- Maintained accurate and up-to-date patient records, including referral status and follow-up information.
- Ensured compliance with healthcare regulations and policies related to patient referrals and data privacy.
- Implemented process improvements to enhance efficiency and effectiveness of the referral coordination system.
- Managed patient referral process from initial consultation to specialist appointment, ensuring timely access to necessary medical services.
- Collaborated with interdisciplinary teams to discuss patient care plans and adjust referral strategies as necessary.
- Adhered to HIPAA requirements to safeguard patient confidentiality.
- Collaborated with multi-disciplinary staff to improve overall patient care and response times.
- Prepared reports, invoices, letters, or medical records using word processing, spreadsheet, or other software applications.
- Maintained detailed records of all patient referrals, including dates of submission, status updates, and any additional information required by insurance providers.
Referral Authorization Coordinator II / Prudent Lay Reviewer
Family Care Inc.
03.2012 - 04.2018
- Responsible for reviewing and approving or denial of hospital admission, as well as reviewing initial reviews for SNF requests, LTAC & IPR requests approval, denial of services
- Coordination of discharge from facilities
- Responsible for Prudent Lay review process
- Supervised and lead project manager of Prudent Lay project to ensure appropriate reviews where performed
- Training and auditing of reviews
- Supervised team including signing of timesheet for payroll and responsible for personnel on daily basis
- Created Policies and Procedures, created PowerPoint presentation as a teaching tool for Prudent Lay and created skilled nursing and Hospital admission Policies, Procedures
- Follow OHA and FamilyCare policies and procedures to ensure compliance standards are met to ensure quality CCO metrics as well as CMS compliance standards are met
QA Auditor
Kaiser Permanente
09.2011 - 01.2012
- Responsible for creating Quality Assurance Process for benefit administration
Service Specialist
Providence Health Plans
05.1998 - 03.2006
- Team Lead / create workflow / meeting minutes
- Insurance verification
- Pricing and claims payment
- Medical terminology
- Provider fee schedules/contracts
- Payment resolution practices for HMO, PPO, TPA line of business
- Medical billing practices for RSVU, Hospital Billing, DRG codes
- Use of HCFA, UB 92 billing
- Employee services/ Quality Work Life Committee/ Senior Safari Days/ Team Birthday Coordinator
Education
Diploma -
Cleveland High School
01.1981
Some College (No Degree) -
Portland Community College
Portland, ORSome College (No Degree) - Power Point, Excel, Word
Microsoft Office Products
Portland, ORSkills
- Critical Thinking Skills
- Analytical Skills
- Excellent customer service skills
- Lead Generation
- Training & Leadership Skills
- Medical terminology
- Referral Intake, Skilled Nursing facility, Long Term Acute Care Facilities
- Inpatient Rehabilitation admission review and discharge Coordination
- Claims processing Medicaid and Medicare
- Follow-up skills
- Supervising and Project management
- Microsoft Office products
- Outlook
- Create & Implement Policies and Procedures
- Familiar with CMS and OHA guidelines
- Knowledge of TPL & Provider contracting
- Claims Auditing
- Membership enrollment & benefit interpretation
- Training & Lead skills
- Motivational Interviewing
- Referral tracking
- Insurance Verification
- Multi-line phone proficiency
- Accurate Documentation
- Insurance precertification processes
- HIPAA Regulations
- MS Office expertise
- Organizational abilities
- Database Management
- Google Suite Proficiency
- Outbound calls
Continued Education
- NCRC Certification, 04/01/18
- Project Fundamentals, FamilyCare, Inc. / Portland Community College
- Integrated Leadership courses, Ted Talks
- Claims Training, Providence Health Plan
- Microsoft Office & Hipaa Training
- Advance Microsoft Office Training, Care Oregon
Accomplishments
- Documented and resolved lack of prudent lay datat which led to improved data of ER admissions.
- Collaborated with team of 6 in the development of provider referral teams.
- Achieved 98% audit score by completing claims payment with accuracy and efficiency.
- Supervised team of 3 staff members.
- Achieved 1/3 reduction of Emergency Room usage per month through effectively helping with creating Prudent Lay data.
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Referral Specialist
Centene Corporation
03.2019 - 12.2023
Referral Authorization Coordinator II / Prudent Lay Reviewer
Family Care Inc.
03.2012 - 04.2018
QA Auditor
Kaiser Permanente
09.2011 - 01.2012
Service Specialist
Providence Health Plans
05.1998 - 03.2006
Diploma -
Cleveland High School
Some College (No Degree) -
Portland Community College
Some College (No Degree) - Power Point, Excel, Word
Microsoft Office Products
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