Health Plan Referral Specialist
Share
Job Location:
Irving, TX - USA
Monthly Salary:
Not Disclosed
Posted on:
7 hours ago
Vacancies:
1 Vacancy
Job Summary
We are seeking a Health Plan Referral Specialist to join our healthcare system team in Irving TX. This is a critical role responsible for processing all referral authorization requests researching claims and ensuring our members receive timely access to the care they need.
You will act as a vital resource for both medical staff and patients ensuring that the behind-the-scenes mechanics of insurance authorizations run smoothly and accurately.
What You Will Do
- Authorization Management: Expedite the flow of requests through the Managed Care System. You will verify eligibility benefits and chart availability to ensure all forms are completed correctly.
- Data Integrity: Accurately enter referral information into our system. A deep understanding of system codes (type status procedure etc.) is essential.
- Communication & Coordination: Notify patients providers and payers (HMO/PPOs) of authorization decisions. You will also coordinate the initiation of Home Health DME services and diagnostics as directed by clinical staff.
- Tracking & Reporting: Utilize our tracking systems to monitor referral flow measure turnaround times and generate reports for management.
- Resource Expert: Serve as the go-to contact for staff regarding managed care systems and contracted provider networks. You will also guide patients through the authorization requirements of their specific insurance plans.
- Administrative Support: Assist in referral research for billing and collections and maintain updated medical files for all authorized activities.
What You Will Bring
- Education: High School Diploma or equivalent (Required proof must be submitted). An Associates degree or higher in an allied health field is preferred.
- Experience: 2 years of experience working in a hospital setting physicians office or managed care organization.
- Technical Skills: Working Knowledge of medical terminology and CPT background typing skills and knowledge of computers
- Interpersonal Skills: Ability to interface professionally with insurance representatives providers and patients to resolve complex needs.
Important Position Details
- Work Environment: This position is 100% onsite in Irving TX. No remote work is available for this role.
- Client Profile: Our client is a comprehensive health system that operates both hospitals and a health plan.
Required Experience:
IC
Key Skills
- Accounts Handling
- Access
- Commissioning
- Biotechnology
- Civil Engineering
- Health And Safety Management
About Company
We are seeking a motivated Promotional Sales Representative to join our client's team and play a key role in building and maintaining relationships with corporate clients. Job Overview: As a Promotional Sales Representative, you will be responsible for identifying, engaging, and manag ... View more
