Referral Specialist Data Entry
Resume:
Shaniece Harris
Referral Specialist II
Park Forest, IL 60466
********.********@*****.***
Authorized to work in the US for any employer
Work Experience
Referral Specialist II
Elevance Health - Chicago, IL
December 2020 to Present
Responsibilities:
• Handled all Outbound calls to Members and Providers to provide services and determination of case review.
• Responding to inbound calls for Peer-to-Peer scheduling between the Medical Doctor’s offices and our AIM Physician Reviewers
• Making outbound calls for connection of Peer-to-Peer appointments between the Medical Doctor’s offices and our AIM Physician Reviewers
• Responding to inbound calls regarding Provider Portal technical issues
• Handles emails and faxes pertaining to existing cases following established processes, meets quality and production standards.
• Create and send written notification to Members and Providers
• Acted as a liaison between hospital, health plans, physicians, patients, vendors and other referral sources.
• Handled and escalated referrals to Leadership as appropriate.
• Contacted physician offices as needed to obtain demographic information or related data.
• Documented communications and actions in system.
• Verify insurance eligibility and benefits for commercial payers utilizing online websites
• Data entry, all demographic and screening information from a requesting physician office or provider via telephone or web-based input into the preauthorization computer system
• Completed preauthorization requests for musculoskeletal types procedures, Radiology procedures as wells as Surgical procedures
Patient Access Specialist
Strivant Health - Tinley Park, IL
June 2020 to November 2020
• Process new referrals that arrive by telephone, email, fax, and website inquiries, in the manner best fitting the needs of the referral source.
• Verify Medicare and Medicaid hospice benefits.
• Notify the Managed Care Department of commercial insurances and managed health care plans.
• Complete admission consent paperwork
• Update referral sources
• Providing financial assistance
• Eligibility verification
• Resolve client account issues
• Analyze members accounts for discrepancies
• Create payment plans on delinquent accounts
• Write-Off balances
• Billing and Coding
• Correct incorrect claims
• Handle escalated calls from client and members
Dental Receptionist
Advance Family Dental - Frankfort, IL
December 2019 to June 2020
• Scheduling appointments/Confirming appointments
• Insurance verification, billing standards,
• Patient intake process, collections, printing assigned doctors while creating patient record forms
• Reviewing Contracts
• Greet patients
• Answer phone calls in a professional and happy manner
• Educate patients on clinic and dental information
• Insurance verification
• Assist patients and new customers with all needs
• Dentrix software
• Check-in patients
• Receive and respond to voicemails in timely manner
• Maintain waiting area
• Remind patients of upcoming appointments
• Assist with administrative duties
Intake Coordinator
The Center for behavioral intervention CBI - Mokena, IL January 2019 to December 2019
• Verified insurance
• Maintained all inbound and outbound calls
• Reviewed Contracts
• Reviewing contracts for the program
• Provided new clients and clinics with parent orientation material
• Explained ABA Therapy and the teaching methods used.
• Tour facility.
• Schedule all new patients for clinical assessment
• Utilized Excel for intake tracking
• Provided resources community resources Families
• Authorizations for services
• Tracked authorizations for potential clients using Microsoft Excel
• Provided updates to patient's family on the onboarding process
• Conducted Manager Meeting to discuss admits and discharges
• Community outreach
Admissions Director
Crestwood Terrace Nursing Center - Crestwood, IL
May 2018 to January 2019
• Inbound calls- outbound
• Behavioral Unit LLC
• Obtain Contracts, Verify insurance
• Tour the Facility
• Obtain referrals. via Epic, All scripts
• Obtain all Behavioral Health Prior Authorizations for Medicaid plans
• Submitting clinical notes for Authorization approvals
• Insurance verification for insurance payers. Verify Medicaid, Medicare, and commercial coverage using a variety of resources
• Admitted resident, discharges, or room transfers to appropriate departments
• Conduct weekly meetings with MCO's reports
• Complete Census
Admissions Director
Providence Nursing Home - Crestwood, IL
January 2017 to May 2018
• Obtained referrals via phone or websites, Epic, Allscripts
• Prior Authorizations
• Verified demographic, clinical, financial, and insurance information during the pre-registration process.
• Admitted resident, discharges, or room transfers to appropriate departments initiate
• Prior Authorizations
• Assisted with the Medicaid/ Medicare application
• Utilized Excel for intake tracking
• Conducted Manager Meeting to discuss admits and discharges
• Community outreach
Admissions Coordinator
VITAS Hospice Healthcare - Lombard, IL
March 2016 to January 2017
Process new referrals that arrive by telephone, email, fax, and website inquiries, in the manner best fitting the needs of the referral source.
• Create Medical records
• Verify Medicare and Medicaid hospice benefits.
• Notify the Managed Care Department of commercial insurances and managed health care plans.
• Call patients and families and offer a same-day appointment
• Explain hospice benefits and services to patients and families
• Complete admission consent paperwork
• Update referral sources
• Verify discharge plans and facilitate the delivery of Home Medical Equipment prior to discharge. Education
High school diploma
Crete-Monee High School - Crete, IL
January 2008 to May 2010
Skills
• Allscripts
• Account Analysis
• Managed Care
• Insurance Verification
• CPT Coding
• ICD-9
• Epic
• Medical Coding
• Medical Records
• Patient monitoring (5 years)
• Customer service (5 years)
• Authorizations (10+ years)
Languages
• American Sign Language - Fluent
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