Twin Peaks Referral Coordinator

Amanda DuPont

**** **** ***** ***** ************,30102

Cell:917-***-****

Email:advfqr@r.postjobfree.com

OBJECTIVE: Looking for a Medical Referral Coordinator position where clerical skills and experience in providing healthcare support services will be fully utilized to strengthen the operations of the facility/Call Center Environment.

KEY QUALIFICATIONS

• Highly skilled in coordinating medical schedules, answering phones and preparing agendas.

• Proven ability to handle personal patient information according to HIPAA regulations.

• In depth knowledge of medical billing and ICD-9 coding.

• Demonstrated ability to maintain patients’ file and record.

• Profound ability to make complex administrative decisions pertaining to policies and regulations.

• Working knowledge of medical terminology in addition to knowledge of the workings of health care practices.

• Proficient in preparing reports based on expenditures and budgets.

• IT – MS Office Suite and relevant hospital software.

EXPERIENCE

Medicaid April 2016- Present

Referrals Coordinator Atlanta GA

• Providing Assistant for Outpatient/offices, such as audiologists, ophthalmologists, and dermatologists.

• Initiate authorization requests for External Referrals.

• Authorized Vendors For Medicaid Patients/Specialty /DME/ Behavior Health Referrals.

• Perform tasks necessary to promote member compliance such as verifying appointments, Faxing lab results. Assess and monitor Approvals on Pending Referrals.

• Verifying eligibility and benefits on Gammis Website

• Identify members without a PCP and refer to Member Services.

• Screen Referrals by priority for case management (CM) assessment.

• Contact the member’s attending physician for DME, other medical providers (home health agencies, equipment vendors) for information pertaining to special needs.

• Produces and mails routine CM letters and program educational material.

Data enter assessments and authorizations into the system

Peach State Health Plan (Aerotek Staffing) September 2014 – April 2016

Member Services Atlanta GA

• Providing Assistant for Outpatient offices, such as dentists, audiologists, ophthalmologists, and dermatologists, often hire patient care coordinators to help patients decide between and prepare for treatment options.

• Initiate authorization requests for output or input services in keeping with the prior authorization list.

• Research claims inquiry specific to the department and responsibility.

• Perform tasks necessary to promote member compliance such as verifying appointments, obtaining lab results. Assess and monitor inpatient census.

• Screen for eligibility and benefits.

• Identify members without a PCP and refer to Member Services.

• Screen members by priority for case management (CM) assessment.

• Perform transition of care duties to include but not limited to, contact the member’s attending physician, member or medical power of attorney, other medical providers (home health agencies, equipment vendors) for information pertaining to special needs.

• Coordinate services with community based organizations. Produces and mails routine CM letters and program educational material.

• Data enter assessments and authorizations into the system.

Fresenius Medical – April 2012 – September 2014

EIC (Electronic Intake Coordinator Atlanta GA

• Working as the liaisons between patients and the healthcare system.

• Provides assistance for members by scheduling appointments for external referral consultations, outpatient’s tests and procedures with our contracted vendors.

• Develops and maintains an awareness of how report compliance issues and concerns.

o Assists and educates members by answering questions regarding referral and authorization process.

EDUCATION High School Diploma –June 2003

Fortis College - March 2016 (Medical Assistant)

Sunrise Assist Living -Direct Care Certification 2006

SPECIAL SKILLS AND CAPABILITIES

• Ability to perform both clerical and administrative support tasks

• Detail oriented with profound ability to work independently

• Excellent communication and interpersonal skills

System Used:

• Epic

• CRM

• Connect

• Citrix

• Sales Force

MMIS (Medicaid System)

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