Theresa Cunningham
Medical
Colorado Springs,CO
Summary
Customer service professional with 24 years of experience providing exceptional patient support in a fast-paced environment. Skilled in resolving complex issues while maintaining a high standard of patient care. Experienced in leading teams to achieve project goals through effective management and strategic planning. Utilizes strong organizational and communication skills to foster collaboration and drive performance. Demonstrates a track record of successfully overseeing project execution and adapting to dynamic work environments.
Overview
24
24
years of professional experience
Work History
Interim Team Lead Referral Authorization Coordinator
Denver Health Utilization Management
04.2022 - 03.2024
- Generate outpatient and inpatient reports to the Utilization Management team
- Instant Message referral coordinators concerning their daily responsibilities
- Monitor staff performance, identify opportunities for efficiencies and reward accomplishments acting as a resource for Referral Coordinators by answering day to day questions, resolve issues, and provide training and coaching
- Conduct phone surveys each month with existing Denver Health Medicare member satisfaction
- Routine Referral Coordinator duties
- Perform other duties as needed and assigned
- Trained new team members by relaying information on company procedures and safety requirements.
Referral Authorization Coordinator
Denver Health Utilization Management
01.2019 - 01.2021
- Performs administrative tasks to make recommendations to our members in need of service as well as relaying important information to companies and organizations
- Process authorizations for the healthcare industry with compliance to insurance requirements
- Answer and respond to calls for Medicare members to obtain an authorization for services
- Facilitate the referrals to contracted provider network and owner hospital facilities
- Ensures accuracy of members eligibility and identifiers to complete the referral request
- Improved patient care by efficiently coordinating authorizations for medical procedures and treatment plans.
- Reviewed authorizations from payer to determine approved or denied items.
- Collaborated with multidisciplinary teams to ensure timely submission of documentation required for insurance approval.
Referral Authorization Specialist
Colorado Springs Orthopedic Group
01.2015 - 01.2019
- Maintain ongoing tracking and documentation on internal and external referrals to promote accurate diagnosis and treatments
- Ensure complete, accurate registration, including patient demographics and current insurance information
- Assemble information concerning patient’s clinical background and referral needs
- Contact review organizations and insurance companies to ensure prior approval requirements are met
- Present & confirm necessary medical information such as history, diagnosis and prognosis
- Review details and expectations about the referral with patients
- Ensure that referrals are addressed in a timely manner
- Strong customer service employed to calm or relieve patient’s concerns
- Organized and able to manage competing priorities effectively
- Able to take responsibility and follow through with all delegated tasks with accountability
- Supported clinical staff by providing timely updates on the status of prior authorizations for various services.
- Optimized workflow processes through effective communication between departments regarding authorization needs and statuses.
Skills
- Proficient in Medical Terminology and documentation
- Advanced expertise in Microsoft Office Suite Word, Outlook, etc
- Skilled in navigating insurance companies and web-based portals
- Experienced with proprietary office software, including Escribe, Centricity, learning company systems
- Strong back ground in coaching, mentoring, and team development
Accomplishments
- Consistently met or exceeded expectations in all areas of performance.
- Managed high-volume workload within a deadline-driven environment while training new employees.
- Demonstrated leadership when other representatives needed assistance.
- Known for enthusiasm, determination and dependability.
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Languages
English
Timeline
Interim Team Lead Referral Authorization Coordinator
Denver Health Utilization Management
04.2022 - 03.2024
Referral Authorization Coordinator
Denver Health Utilization Management
01.2019 - 01.2021
Referral Authorization Specialist
Colorado Springs Orthopedic Group
01.2015 - 01.2019
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