Health Plan Referral Specialist
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Job Location:
Irving, TX - USA
Monthly Salary:
Not Disclosed
Posted on:
8 hours ago
Vacancies:
1 Vacancy
Job Summary
Job Summary: Health Plan Referral Specialist
- Process all requests for referral authorizations within the managed care system.
- Research and resolve problem referral claims or requests for payment.
- Expedite the flow of authorization requests by preparing and verifying all necessary documentation (form completion eligibility chart availability benefits etc.).
- Accurately enter and maintain referral and authorization information using computer systems and correct coding (type status procedure etc.).
- Notify patients and providers about authorization decisions.
- Maintain accurate tracking of all referral and authorization activities.
- Generate and print system reports to support daily tasks and management reporting.
- Use tracking systems to monitor and measure the progress and turnaround times of referrals.
- Meet applicable competency expectations for the role.
- Collaborate with other healthcare team members to ensure efficient referral processing.
Requirements:
- High School Diploma or equivalent (proof required).
- Working knowledge of medical terminology and CPT codes.
- Proficient typing and computer skills.
- Minimum 2 years experience in a hospital physician office or managed care organization.
- Process all requests for referral authorizations within the managed care system.
- Research and resolve problem referral claims or requests for payment.
- Expedite the flow of authorization requests by preparing and verifying all necessary documentation (form completion eligibility chart availability benefits etc.).
- Accurately enter and maintain referral and authorization information using computer systems and correct coding (type status procedure etc.).
- Notify patients and providers about authorization decisions.
- Maintain accurate tracking of all referral and authorization activities.
- Generate and print system reports to support daily tasks and management reporting.
- Use tracking systems to monitor and measure the progress and turnaround times of referrals.
- Meet applicable competency expectations for the role.
- Collaborate with other healthcare team members to ensure efficient referral processing.
Requirements:
- High School Diploma or equivalent (proof required).
- Working knowledge of medical terminology and CPT codes.
- Proficient typing and computer skills.
- Minimum 2 years experience in a hospital physician office or managed care organization.
Key Skills
- Accounts Handling
- Access
- Commissioning
- Biotechnology
- Civil Engineering
- Health And Safety Management
