Referral Coordinator/Liason
Resume:
Roselyn Prasad
Sacramento, California
**********@*****.***
Objective
Seeking a position in a challenging environment where I can apply my acquired skills and education while giving my best to an employer.
Principal Duties and Responsibilities
• Knowledge to verify eligibility & benefits for each submitted physician referral by contacting the health plans for pertinent information.
• Knowledge to process and complete authorization request forms into the company's in-house system in a consistently accurate and timely manner, as well as referring the authorization request forms to the appropriate staff members for processing.
• Accuracy in processing referrals at or above the bench-mark processing daily quota.
• Maintains communication in a timely manner, the authorization request form disposition back to the appropriate staff, physicians, and facilities.
• Maintenance in organizing & acting upon pended, denial files/cases in a timely manner to maintain designated turnaround times and physician communication.
• With courtesy, answers telephone calls coming in and from insurance companies, patients, medical facilities and staff and specialty physicians.
• Provide requested referral and network information to providers/staff in a timely manner.
• Provides and effectively communicates information to providers, nursing staff regarding referrals that are not a covered benefit and facilitate denial letters and any other issues that may arise regarding the authorization requests.
• Organizes, manages and prioritizes workload effectively with the goal of processing authorization requests within the established time frame.
• Refers patients to appropriate facilities, specialty physicians in accordance to patient’s health plan.
• Performs other duties as assigned.
• Maintains a courteous and professional demeanor in all interactions, with all persons both inside and outside the office.
Experiences:
One Community Health formerly CARES Community Health
1500 21st Street
Sacramento, CA 95818
Referral Coordinator
June 2014-Present
Metropolitan Pain Management Consultants
Sacramento, California
Referral /Workers Compensation Coordinator
October 2011- 2014
Family Doctors of Green Valley
Las Vegas, Nevada
Referral Coordinator- Admin Assistant
March 2005-October 2011
India /Fiji Market (Family Business)
Co-Owner /Manager
Feb 2005-December 2010
Dr. Jane Hamersely
San Francisco, California
Medical Assistant/Phlebotomist
July 1992- January 1994
Mullikin Medical Center
Daly City, California
Medical Assistant /Phlebotomist
Feb.1994-Sept.1996
International Christian School
San Francisco, California
School Secretary/Bookkeeper
December 1990- June 1992
Education
Bryman College
San Francisco, California
Certified Medical Assistant
June 1994
Balboa High School
San Francisco, California
High School Diploma
June 1992
Related Skills
• Clear and accurate knowledge of medical terminology; managed care experience and worker’s compensation processing
• Working knowledge of ICD-10 & CPT codes, Word, Excel and Scanning Technology.
• Demonstrated computer literacy, NEXT GEN, Epic and EMR Experience.
• Excellent communication skills in both oral and written modes, as well as superior telephone etiquette.
• Excellent customer services experience and proficiency.
Work Ethics
1. Maintains good customer relationships with both provider office staff and providers as well as effective and courteous communication with internal staff.
2. Effectively manages and prioritizes workflow of daily provider authorization requests and to accomplish a timely turn-around time.
3. Positively contributes to the utilization management team via effective communication and problem solving within framework established by the department.
References available upon request
Contact this candidate