Supervisor - Referral Services Resume Jackson, MS - Hire IT People

OBJECTIVE:

Obtaining a position within your company to utilize my education as well as my experience within a corporate environment.

SUMMARY:

Formal education in Business Administration with exposure to computer operation and programming
26 years demonstrated effectiveness as a customer service representative
22 years demonstrated effectiveness as an administrative assistant
Dedicated to professionalism, highly motivated toward goal achievement

PROFESSIONAL EXPERIENCE:

Confidential, Jackson, MS

Supervisor - Referral Services

Responsibilities:

Supervise the day to day operations of the utilization and case management areas
Supervise day to day activities of the Referral Services department including work flow, training, hiring, ect.
Assist providers, members and/or internal customers with cases pertaining to referral questions, issues and authorizations
Reconcile pended claim issues in a timely manner per health plan/department procedure
Review and process denial letters, maintain logs and coordinate decisions to external and internal personnel per plan procedures
Receive and review incoming phone and case management log reports and determine course of action
Work with analysts and programmers in adapting and testing programs and procedures to adhere to our standard operating procedures

Project Coordinator

Confidential

Responsibilities:

Track and coordinate projects to ensure prescribed activities are carried out in accordance with specified objectives.
Act as a liaison between department and project management software or key project personnel.
Coordinate various projects as assigned. Assist in ensuring compliance with departmental policies.
Coordinate with key personnel to perform functions as determined by departmental needs.
May act as backup to the Administrative Assistant function.
Screen for eligibility and benefits.
Research claims inquiry specific to the department and the responsibility.
Train new employees for the utilization department (prior authorization)
Provide technical support to staff and provider ongoing training.
Stream line training documents, coordinate department procedures, as well as complete special projects
Conduct new hire interviewing

Referral Specialist

Confidential

Responsibilities:

Assist in monitoring utilization of medical services to assure cost effective use of medical resources through processing prior authorizations and act as trainer and mentor to less experienced staff.
Initiate authorization requests for outpatient services in accordance with the prior authorization list. Route to appropriate staff when needed.
Verify eligibility and benefits.
Answer phone queues and process faxes within established standards.
Data enters authorizations into the system

Confidential, Jackson, MS

Physician Scheduler

Responsibilities:

To coordinate and manage provider schedules to maximize customer service, patient access, provider productivity and business operations.
To complete the pre-registration process including using practice management software to track demographics.
To make referrals for financial counseling and/ or physician referrals/authorizations/certifications.
To verify payment of visits/coordinate all insurance information for payment.
Schedule all doctor inpatient and outpatient appointments.
Administrative assistant duties including doctor dictation.
Answer incoming calls while operating a 6-line switchboard phone system.
Make all new patient charts and register new patients
Insurance verification, Medical office experience

Confidential, Jackson, MS

Assistant to Divisional Secretary

Responsibilities:

Insure all divisional vehicles and property.
Recruitment of volunteers and resources.
Administrative assistant duties. Purchase & control all major purchases of supplies and equipment
Process all requisitions and PD5’s.
Answer incoming calls while operating a 10-line switchboard phone system.
Opening and closing manager when store manager and assistant manager are not in the store.
Pulling reports and setting up floor sets.
Assisting customers with purchases.

Confidential, Jackson, MS

Senior Membership Specialist

Responsibilities:

Promptly and accurately resolve electronic enrollment pend transactions
Resolve error identification, research and problem resolution
Make logical processing decisions based on knowledge of business processed without routine involvement or assistance from other staff