Robin Wessell-Hammond
Tulare
Summary
Experienced professional in healthcare administration, specializing in workflow optimization and staff training. Dedicated to enhancing patient care through effective coordination and collaboration, ready to support organizational growth and improve operational standards.
Overview
17
17
years of professional experience
Work History
Insurance Supervisor
Valley ENT
Visalia
10.2021 - Current
- Supervised referral and authorization processing for patients at Valley ENT.
- Trained staff on insurance policies and procedures compliance.
- Managed daily department operations, including staffing schedules and work distribution, to ensure a smooth workflow.
- Reviewed claim submissions for accuracy and completeness, ensuring compliance with industry standards.
- Resolved customer complaints regarding insurance coverage and billing issues.
- Resolved patient inquiries related to insurance coverage and claims.
- Coordinated communication between patients and insurance providers.
- Collaborated with healthcare teams to streamline patient billing processes.
- Conducted performance appraisals for subordinates through verbal and written feedback, fostering staff development.
- Maintained updated knowledge of industry regulations and policies.
- Provided training on new products and services as they become available in the market.
- Supported the establishment of a new otolaryngology practice. Designed and executed workflows for authorization, referral and billing operations. Assisted in recruitment efforts and expansion into three cities with multiple offices.
Medical Referral Specialist
Kaweah Health
Visalia
07.2009 - 10.2021
- Coordinated patient referrals to specialist providers efficiently and accurately.
- Managed communication between patients and healthcare providers for seamless service.
- Ensured compliance with healthcare regulations during the referral process.
- Utilized electronic health record systems to track referral status and updates.
- Assisted patients in understanding their referral options and procedures clearly.
- Maintained organized records of referrals to facilitate easy access and review.
- Collaborated with interdisciplinary teams to enhance referral workflows effectively.
- Educated staff on referral protocols to standardize processes across departments.
- Tracked referral request progress and resolved issues to maintain smooth processing.
- Managed and obtained insurance authorizations for patient referrals from physicians.
- Liaised with healthcare facility personnel, insurance representatives, physicians and vendors for smooth communication.
- Gathered and verified insurance requirements to meet payer requirements.
- Adhered to HIPAA regulations when dealing with confidential patient information.
- Entered confidential patient information and updated electronic records in database.
- Assisted patients by answering questions and providing information regarding referrals.
- Aided clinical team to support administrative needs for clinical referrals.
- Coordinated referral orders for patients of provider.
- Obtained PA for services such as diagnostic imaging.
- Monitored status updates on referred cases from third party vendors.
- Responded promptly to inquiries from patients, physicians, and other stakeholders regarding the status of referred cases.
- Called insurance companies to confirm coverage specifics for procedures requested by the referring physician.
- Processed authorization requests from referring physicians in a timely manner.
- Maintained databases of active referrals and tracked progress of each case until completion.
- Provided support for administrative tasks related to medical referrals such as filing paperwork, scanning documents.
- Reviewed patient records and verified insurance eligibility.
- Assessed potential referral delays due to lack of prior authorization from insurance carriers.
- Researched providers to determine if they are in-network or out-of-network for the patient's health plan.
- Developed relationships with internal departments and external entities related to medical referrals.
- Coordinated referrals with primary care physicians, specialists, and other healthcare providers.
- Advised referring physicians on changes made to insurance policies that may affect their ability to refer patients.
- Evaluated current referral practices against industry standards and best practices.
- Prepared referral documents containing patient information, diagnosis codes, treatment plans, and provider information.
- Transmitted medical records and other correspondence by mail, e-mail, or fax.
- Communicated with patients with compassion while keeping medical information private.
- Collaborated with multi-disciplinary staff to improve overall patient care and response times.
Education
Some College (No Degree) - General/Healthcare Administration
College of The Sequoias
Visalia, CA07-2026
Skills
- Patient coordination
- Project management
- Workflow design
- Data analysis
- Employee training
- Staff management
- Industry trends
- Customer service
- Build customer relationships
- Effective communication
- Communication skills
- Problem-solving abilities
- Problem-solving aptitude
- Prioritizing and planning
- Team building leadership
- Active listening
- Proactive and focused
Timeline
Insurance Supervisor
Valley ENT
10.2021 - Current
Medical Referral Specialist
Kaweah Health
07.2009 - 10.2021
Some College (No Degree) - General/Healthcare Administration
College of The Sequoias