Health Plan Referral Specialist

H

HJ Staffing

Health Plan Referral Specialist

Irving, TX
Full Time
Paid
  • Responsibilities

    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 Associate's degree or higher in an allied health field is preferred.

    • Experience: 2+ years of experience working in a hospital setting, physician's 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.