A professional health care customer service representative with 5+years of experience, solid work ethics and determination to excel within a company that offers development and growth opportunities.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Referral Coordinator
Kaiser Permanente
Atlanta, GA
04.2017 - Current
Responsible for completing external referral requests received via Health Connect and OnLine Affiliate with appropriate CPT/HCPCS codes and to ensure correct ICD10 codes have been entered.
Responsible for notifying members regarding referral /authorization orders.
Assigns appropriate CPT/HCPS procedure codes following coding guidelines for all referral requests and to ensure appropriate ICD-10 codes have been entered on all requests.
Builds effective working relationships with physicians/staff, QRM staff, and other departments within the health plan. Identifies and reports problems and inefficiencies in existing systems and recommends changes when appropriate to the Referral Coordinator Supervisor.
Maintains members confidentiality. Knowledgeable and compliant with regional personnel policies and procedures.
Home Health Referral Coordinator
Kaiser Permanente
Atlanta, GA
04.2016 - 04.2017
Process Home Health orders from providers and vendors.
Answer incoming calls from vendors to inquire about referrals / change of start of care date.
Work continuously with our contracted Home Health vendors to receive referrals.
Knowledgeable and compliant with QRM departmental policies and procedures.
Contract
Referral Coordinator
Peach State Health Plan
Atlanta, GA
08.2015 - 03.2016
Initiate authorization requests for Outpatient, Inpatient, LTAC, DME, Home Health Care, Transportation, Genetic Testing and Rehabilitation Services accordance with the prior authorization list.
Generate approval letters to providers and facilities.
Review and attach medical records to authorization and task to nurse reviewer for processing.
Contact provider’s office / hospitals for additional information needed for authorization request
Auto Approve certain authorizations (Visits and Deliveries) and create approval letter for provider.
Education
High School Diploma - General Studies
College of Lake County
Grayslake, IL
Skills
Critical thinking, problem solving, and computer skills to all inpatient and outpatient data
Excellent organization and time management skills
Strong communication skills (written and verbal) and data entry skills
Working knowledge and use of the up-to-date CPT/HCPCS codes
Proficient with Microsoft Office Suite (Word, Excel, etc)
Medical Receptionist/Front Desk/Referral coordinator/ Patient Care Coordinator/MA at VERIMED Health Group of BradentonMedical Receptionist/Front Desk/Referral coordinator/ Patient Care Coordinator/MA at VERIMED Health Group of Bradenton
Outpatient Administrative Specalist at SUNY Upstate Medical University HospitalOutpatient Administrative Specalist at SUNY Upstate Medical University Hospital