Emily Edwards
Reno
Summary
Experienced Referral Specialist with a comprehensive background in nursing and healthcare operations. Proven ability to coordinate care between multiple providers and optimize referral workflows, ensuring timely patient care. Committed to maintaining high standards of professionalism and fostering strong patient-provider communication.
Overview
30
30
years of professional experience
Work History
Referral Specialist
Skin Cancer and Dermatology Institute
07.2025 - Current
- Coordinated scheduling across 11 locations and 40 providers in high-volume call center, enhancing patient access to care.
- Processed referrals by verifying insurance regulations and ensuring timely patient scheduling, improving overall patient flow.
- Verified insurance coverage and secured necessary pre-authorizations for services.
- Communicated lab biopsy results to patients and coordinated follow-up with providers, ensuring clarity and continuity of care.
- Identified issues and implemented solutions to reduce backlog and enhance workflows.
- Guided patients through complex healthcare systems, offering resources and advice.
Prior Authorization Coordinator/Referral Specialist
East Asheville Family Health Care
Black Mountain
06.2020 - 04.2025
- Reviewed medical records and gathered documentation for prior authorization requests, ensuring compliance with insurance requirements.
- Communicated with insurance companies to determine coverage and benefit eligibility.
- Collaborated with healthcare providers to obtain required clinical information for approvals.
- Resolved denied authorizations by providing additional information or appealing decisions, facilitating timely patient care.
- Trained new team members on prior authorization processes and company policies, enhancing team knowledge and efficiency.
- Supported case management team with coordinating care between multiple providers and specialists.
- Worked remotely during training transition for replacement
Prior Authorization and Referral Specialists
Pinnacle Medical Group
01.2024 - 04.2025
- Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
- Ensured proper authorization of referrals by insurance providers to facilitate patient care.
- Performed detailed medical reviews of referral requests, following established criteria and protocols.
- Reviewed precertification requirements for accuracy and compliance to meet regulatory standards.
- Notified ordering providers of issues with referrals and outlined necessary steps for appeals.
- Demonstrated adaptability in changing work environments and processes.
Staff Nurse
MAHEC Women's Health Center
Asheville
08.2000 - 10.2008
- Provided nursing care to patients under supervision of physicians and midwives. for the physicians and nurse midwives
- Served as primary nurse for urogynecologist, performing biofeedback, assisting in urodynamics, and coordinating surgical schedules.
- Provided direct patient care, including post-C-section wound care, post bladder/rectal repair, i.e., staple removal, and packing.
- Conducted diagnostic tests including blood draws, urine analysis, biofeedback, NSTs, and triage for acute patient needs.
- Communicated effectively with patients, families, physicians, and healthcare staff to ensure comprehensive care.
Staff Nurse
MAHEC/Regional
Asheville
08.1996 - 10.2000
- Identified symptoms and recommended treatments or follow-up care based on established protocols and guidelines.
- Managed multiple tasks simultaneously, ensuring quality standards of care were consistently maintained.
- Achieved departmental goals and objectives by instituting new processes and standards.
- Answered high-volume incoming calls from patients seeking medical advice or assistance, enhancing patient access to care.
- Assisted in the writing of protocols specific to our practice.
- Referred patients to specialized health resources or community agencies to furnish additional assistance.
- Provided mentorship and training to new staff members, facilitating their understanding of protocols and procedures.
- Maintained updated knowledge through continuing education and Advanced training
Education
Bachelor’s - nursing
South College
Asheville06-2019
Licensed Practical Nursing -
Clevland Community College
Shelby08-1991
Prerequisites - nursing
Mars Hill University
01-1989
High School -
Mountain Heritage High School
Burnsville, NC06-1988
Skills
- Authorization processes
- Medical coding
- Task prioritization
- Organizational skills
- Adaptability and flexibility
- Effective communication
- Patient advocacy
Timeline
Referral Specialist
Skin Cancer and Dermatology Institute
07.2025 - Current
Prior Authorization and Referral Specialists
Pinnacle Medical Group
01.2024 - 04.2025
Prior Authorization Coordinator/Referral Specialist
East Asheville Family Health Care
06.2020 - 04.2025
Staff Nurse
MAHEC Women's Health Center
08.2000 - 10.2008
Staff Nurse
MAHEC/Regional
08.1996 - 10.2000
Bachelor’s - nursing
South College
Licensed Practical Nursing -
Clevland Community College
Prerequisites - nursing
Mars Hill University
High School -
Mountain Heritage High School