Serena Summers
Referral Management
Portland,TN
Summary
Highly organized and detail-oriented Referral Coordinator with expertise in managing patient referrals and scheduling appointments across multiple specialties. Proficient in medical terminology, insurance verification, and triaging patients to appropriate providers. Skilled in providing exceptional customer service, collaborating with clinical staff, and implementing best practices for efficient referral processing.
Pursuing full-time role that presents professional challenges and leverages interpersonal skills, effective time management, and problem-solving expertise.
Demonstrates strong analytical, communication, and teamwork skills, with proven ability to quickly adapt to new environments. Eager to contribute to team success and further develop professional skills. Brings positive attitude and commitment to continuous learning and growth.
Thorough team contributor with strong organizational capabilities. Experienced in handling numerous projects at once while ensuring accuracy. Effective at prioritizing tasks and meeting deadlines.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Referral Management (Remote)
Vanderbilt University Medical Center
Nashville, TN
11.2023 - Current
- Transitioned to lead referral management initiatives, enhancing collaboration between departments.
- Ensured precision in patient demographic and insurance data to support administrative processes.
- Achieved scheduling for referring providers and patients, resulting in improved appointment adherence. Enhanced operational efficiency through effective management of scheduling processes, leading to increased patient engagement and satisfaction.
- Managed escalation process for emergency calls to prioritize urgent situations and enhance operational efficiency.
- Streamlined patient triage processes to match individuals with relevant specialty care providers.
- Managed 70+ incoming calls regarding referrals in a professional manner while providing accurate information.
- Assisted and educated patients by answering questions regarding referral and authorization process.
- Ensured compliance with healthcare regulations and guidelines to enhance referral coordination processes.
- Provided excellent customer service by responding promptly to inquiries from both internal and external customers.
- Self-motivated, with a strong sense of personal responsibility.
- Worked effectively in fast-paced environments.
Patient Support Specialist (Remote)
Vanderbilt University Medical Center
Nashville, TN
07.2022 - Current
- Inbound communication for internal medicine & primary care providers
- Scheduling new and established patients
- Screening patients with urgent symptoms effectively communicating to clinical staff
- Prescription refill requests
- Provided compassionate support to patients during treatment and recovery phases.
- Coordinated communication between healthcare providers and patients, ensuring clarity of care instructions.
Authorization Specialist (Remote)
Parallon
Nashville, TN
03.2019 - 12.2021
- Promotion to Authorization Specialist
- Processed prior authorizations requests within established time frames.
- Provided excellent customer service to patients via phone, email, or in person inquiries.
- Prepared and processed authorization forms for various insurance companies, ensuring accuracy of information.
- Maintained up-to-date knowledge of insurance guidelines and regulations.
- Worked closely with internal departments to identify resolution strategies for denials and underpayments.
- Participated in quality assurance activities such as audits, peer review, chart reviews and other initiatives.
- Developed strong relationships with external customers, including insurance providers and medical offices.
- Ensured that all relevant documents were submitted correctly for each authorization request.
- Collaborated closely with clinical staff to ensure accurate coding of diagnoses and procedures.
- Researched complex claims issues and resolved discrepancies between provider systems and payers’ systems.
- Analyzed patient records to determine eligibility for health care services.
- Stayed current with changes in rules, laws and procedures to maintain timeliness and accuracy.
- Coordinated insurance authorization processes to ensure timely patient care.
- Analyzed patient records and insurance information for accurate eligibility determination.
Registrar
Parallon
Nashville, TN
04.2017 - 12.2021
- On-site registrar for Skyline Medical Center, Centennial Medical Center, Summit Medical Center, Hendersonville Medical Center
- Registrar Outpatient and Inpatient
- SDC procedures, CT scans, MRI, Mammograms, X-ray, Lab work
- Verify patient insurance through OneSource and eCare next
- Pre-cert and Authorizations obtain also verifying medical necessity for Medicare
- Scanning physician orders, ID cards through FOS
- Obtaining all necessary consents HIPAA and Medicare forms
- Implemented electronic health record systems enhancing data accuracy and accessibility.
- Oversaw patient registration process ensuring compliance with healthcare regulations.
Financial Counselor
Parallon
Nashville, TN
10.2018 - 03.2019
- Promotion to Financial Counselor Summit Medical Center
- Provide estimated costs to patients
- Assist patients with payment arrangements and coordinate with RCPS
- Complete financial analysis reports and collect patient liabilities
- Follow up with patients for necessary signatures
- Utilize eligibility systems, on-line websites or phone calls to determine insurance benefits.
- Maintained accurate records of all transactions related to clients’ accounts.
- Created customized financial plans tailored specifically to each individual’s needs.
- Ensured compliance with all relevant laws and regulations pertaining to financial matters.
- Utilized software tools to monitor client accounts for accuracy and compliance with regulations.
- Provided financial counseling to patients, enhancing understanding of insurance options and payment plans.
- Facilitated communication between patients and insurance companies, resolving billing discrepancies effectively.
Clear Vision Coordinator / Scheduler - Medical Facility
Loden Vision Centers
Goodlettsville, TN
11.2016 - 03.2017
- Answer incoming calls and schedule appointments for 5 different locations
- Utilize iMedicWare to schedule patient appointments, and make outbound calls to confirm appointments
- Accept calls from referring physicians and enter authorizations from PCP
- Triage patients to determine medical urgency for scheduling purposes
- Extensive training with glaucoma, diabetic, LASIK, YAG, emergency retina detachments, cataracts, complete eye exams, and dry eye conditions.
- Coordinated patient scheduling to optimize clinic workflow and minimize wait times.
- Implemented electronic health records system, improving data accuracy and accessibility for staff.
Call Center Trade Specialist/ Supervisor
Innovations In Management
Portland, TN
03.2014 - 11.2016
- Integrate software systems and programs
- Enter service requests into the systems and call to confirm with the store manager the exact maintenance issue that needs to be addressed
- Manage invoicing, answer calls, and direct employees on how to resolve problems
- Investigate and work to create permanent solutions
- Run Excel reports, distribute work, and answer emails efficiently and in a timely manner.
- Analyzed trade regulations to ensure compliance with international standards.
- Developed strategic partnerships to enhance supply chain efficiency and reduce costs.
Customer Service Representative
Regional Finance
Lebanon, TN
04.2011 - 05.2012
- Accountable for solicitation of new customers and follow-up with potential applicants
- Reviewed applicants’ credit history, called references, and made daily bank deposits
- Entered customer data accurately and made sure applications were complete
- Managed closings on small loans which included typing up contracts and explaining to the customers every detail of the contractual agreement they were signing
- Accepted and processed payments and called delinquent clients
- Performed solicitation for renewal of loans.
- Resolved customer inquiries efficiently, enhancing satisfaction and retention rates.
- Trained new staff on customer service protocols and company policies.
Retail Store Manager
Cato Fashions
White House, TN
10.2008 - 04.2011
- Began as a part-time associate; promoted to store manager
- Hired and trained new employees and took care of employee evaluations, completing all paperwork
- Ran all daily reports for sales and ensured employee signatures were always collected
- Oversaw weekly shipments, scanning all cartons received and taking care of all paperwork
- Made sure that the team met sales goals, counted down cash drawers, and made daily bank deposits
- Practiced loss prevention procedures and performed other retail-related duties as required
- Complied with customer confidentiality policies and practices.
- Directed daily operations to ensure optimal store performance and customer satisfaction.
- Trained and mentored staff to enhance service quality and operational efficiency.
Education
Bachelor of Science - Health Information Management
Western Governors University
Salt Lake City, UT07-2027
Associate of Applied Science - Health Information Management
Ultimate Medical Academy
Clearwater, FL05-2017
Skills
- Medical Terminology
- Medical Billing & Coding
- HIPAA Compliance
- EMR/EHR Systems
- Insurance Verification
- Medical Records Management
- Patient Scheduling & Triage
- Microsoft Office (Excel & Word)
- Data Entry & Typing
- Office Administration
- Customer Service
- Team Leadership & Training
- Communication Skills
- Time Management
- Problem-Solving
- Sales & Account Management
- Retail & Front Desk Operations
- Financial & Data Analysis
- Organizational Skills
Certification
- High Academic Honors/ Deans List 2015 to 2017
- Certified Patient Account Representative, Healthcare Management Resources - 2001
Timeline
Referral Management (Remote)
Vanderbilt University Medical Center
11.2023 - Current
Patient Support Specialist (Remote)
Vanderbilt University Medical Center
07.2022 - Current
Authorization Specialist (Remote)
Parallon
03.2019 - 12.2021
Financial Counselor
Parallon
10.2018 - 03.2019
Registrar
Parallon
04.2017 - 12.2021
Clear Vision Coordinator / Scheduler - Medical Facility
Loden Vision Centers
11.2016 - 03.2017
Call Center Trade Specialist/ Supervisor
Innovations In Management
03.2014 - 11.2016
Customer Service Representative
Regional Finance
04.2011 - 05.2012
Retail Store Manager
Cato Fashions
10.2008 - 04.2011
Bachelor of Science - Health Information Management
Western Governors University
Associate of Applied Science - Health Information Management
Ultimate Medical Academy