SUMMARY

An IT specialist with strong customer service and critical thinking skills. Worked in the health insurance industry with strong knowledge of Electronic Medical Record systems and information technology. Known to be hard working, goal oriented, and a problem solver to create a more efficient work environment. Able to establish rapport and credibility with diverse groups ranging from members/customers to executives.

PROFESSIONAL EXPERIENCE

HealthSpan/Kaiser Permanente, Cleveland, OH

Referral Specialist 2005-2017

Promptly responded to general inquiries from members, staff and Health Providers via, telephone, e-mail, mail and fax.

Successfully supported the implementation of Tapestry Utilization Management.

Developed highly empathetic client relationships and earned reputation for delivering exceptional provider service.

Assisted in creating workflows/policies and procedures that were used to train employees on new systems and processes.

Performed departmental training for new employees on referral process

Managed accurate department files.

Processed referrals within government regulated time frames to ensure members received care in a timely fashion.

Cross-trained and provided back-up for other referral specialist when needed.

Participated in weekly referrals work-group meetings.

Successfully met all ongoing assigned multiple tasks.

Customer Relations 2003-2005

Answer customer telephone calls regarding their health plan.

Responded to questions and concerns about service, escalating when appropriate.

Consistently improve customer satisfaction through expert resolution of conflicts, issues, and concerns.

EDUCATION

High school Diploma

A+ and Network+ Certifications

SOFTWARE/SYSTEMS

Microsoft: Word, Excel, Power Point, Outlook

Epic Tapestry- Utilization Management and Referrals

OnBase

Conifer

Diamond (referral entry)

Macess

Rightfax

CPT and ICD-10 coding

Linux (Ubuntu)

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