Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

CHRISTAL JONES

Austell,GA

Summary

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)
  • HIPPA/PHI compliance
  • EPIC Software
  • Tricare (Humana portal)
  • GAMMIS (Medicaid portal)
  • MS Excel
  • MS Outlook

Certification

Libman certificate for medical coding

Timeline

Referral Coordinator

Kaiser Permanente
04.2017 - Current

Home Health Referral Coordinator

Kaiser Permanente
04.2016 - 04.2017

Referral Coordinator

Peach State Health Plan
08.2015 - 03.2016

High School Diploma - General Studies

College of Lake County
CHRISTAL JONES