Health Plan Referral Specialist

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.

• 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.

• 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.

• 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.