Customer Service Referral Specialist

KENTON O’LEARY

Tampa, FL ***** 813-***-**** ad5og7@r.postjobfree.com

REFERRAL SPECIALIST

Proven customer service and management experience. Recognized by management for accomplishing objectives quickly and efficiently. Impactful, professional, adept at mentoring, communications, and problem solving coupled with a strong ethic, meeting company goals and objectives. Resourceful in insurance strategy and overseeing programs requiring strong partnerships and complex change management.

Core competencies include:

Project Management Documentation Compliance Account Management Business Policy and Strategy Authorizations Provider Network Knowledge Utilization Management Provider Relations

EXPERIENCE

Centene Corporation, Tampa, FL (formerly WellCare) August 2014 - Present

Referral Specialist

Administer and support clinical care management, coordinate services, performs actions related to various cross functional projects in achievement of company and departmental goals.

Perform in the reorganized Intake Department, with a case load of over 1000 per day, in 5 regions/teams, improving contractual compliance, accomplishing cost effectiveness, and achieving member satisfaction.

Provide technical and administrative guidance to clinical staff to ensure exceeding the goal of 50 completed cases per day.

Serve as a liaison in communicating and corresponding with vendors, contacts, and members ensuring accurate information per case.

Produce, format, and edit documents and correspondence for special project cases requiring completion prior to the contracted deadline to avoid penalties.

Organize and prioritize administrative and clinical routines impacting members, resulting in improved turnaround time to within 48 hours and reducing costs by several thousand dollars annually.

Expedite the accomplishment of nursing tasks during heavy transaction periods, including but not limited to faxes, requests for clinical information, and creation of authorizations further reducing turnaround time, case load, and cost.

Aetna, Tampa, FL (formerly Coventry Health Care) August 2010 - August 2014

Integrated Service Specialist, January 2013 - August 2014

Developed solutions for pricing problems, answered technical/procedural questions, and continuously promoted goodwill and quality customer service throughout the process.

Assisted clients and providers with questions regarding bill issues.

Verified and updated provider network status and demographic information.

Responded to questions from clients, account managers, and adjusters.

KENTON O’LEARY ad5og7@r.postjobfree.com PAGE 2

Pre-Authorization Representative, August 2010 - December 2012

Coordinated and processed workers compensation claims for utilization review. Assisted in educating and acted as a resource to primary care practices and specialty care providers.

Provided direct support to primary care practices and specialty care providers regarding utilization, authorization, and referral activities.

Entered data referrals for non-complex services including DME, physical therapy, inpatient and outpatient care, behavioral health services and testing as applicable, and special circumstance requests as defined by Utilization Management.

Assisted in gathering information needed for coordinators/case managers to determine continued authorization.

ADDITIONAL RELEVANT EXPERIENCE

United Healthcare, Oldsmar, FL

Claims Processor/Adjuster

Responsible for processing/adjusting claims for specific company policies. Specializing in Medicare and large group policies.

Processed and adjusted more than 60 claims daily for over 30 different clients.

Maintained tight, cohesive team atmosphere for in-house and telecommuting associates.

Utilized multiple forms of platforms to perform duties.

Spheris Corporation, St. Petersburg, FL

Customer Service Representative

Responsible for facilitating professional customer service responses, in a fast-paced service environment, requiring navigation of multiple medical transcription custom platforms to rapidly address client requests.

Communicated with over 500 facilities to assist in locating, escalating, and delivering transcriptions.

Operated various computer platforms / software in achieving and maintaining organizational standards.

Coached and trained new employees in the development and improving performance while building strong client relations.

Maintained a strong, positive environment with team while contributing ideas, offering solutions, and assisting with challenges.

Eckerd Corporation, Tampa, FL

Assistant Manager

Comanaged daily store activities overseeing daily sales, operations, and human resources of a fast-paced $5 million retail store.

EDUCATION

Master of Business Administration, MBA, Tampa College, Tampa, FL

Bachelor of Arts, BA, University of South Florida, Tampa, FL

SOFTWARE SKILLS

Microsoft Word XP Excel Outlook Windows Microsoft Office Desktop Software

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