Referral Specialist
Job in
Irving, Dallas County, Texas, 75084, USA
Listed on 2026-01-23
Listing for:
SNI Companies
Full Time
position Listed on 2026-01-23
Job specializations:
-
Healthcare
Healthcare Administration, Medical Billing and Coding, Health Informatics, Medical Records
Job Description & How to Apply Below
- Process and expedite referral authorization requests through managed care systems.
- Prepare authorization requests by verifying required documentation, eligibility, benefits, and chart availability.
- Accurately enter and maintain referral and authorization data within internal systems, ensuring correct use of codes (procedure, type, status, etc.).
- Track and document authorization decisions and notify all involved parties, including patients, providers, and payer representatives.
- Monitor referral workflows using tracking systems to ensure timely turnaround and compliance with processing standards.
- Generate and analyze system reports to support daily operations and management reporting.
- Coordinate scheduling and follow-up for diagnostic services, home health, DME, and other authorized services as directed by clinical staff.
- Distribute referral documentation appropriately and ensure accurate record-keeping in both medical records and electronic systems.
- Serve as a resource to staff and providers regarding managed care processes, HMO/PPO benefits, and contracted provider guidelines.
- Assist with referral research related to billing and collections.
- Communicate with payer agencies and external organizations to resolve issues and exchange updated resource information.
- Provide guidance to patients navigating the referral and authorization process to improve understanding of insurance requirements.
- Promote collaboration among providers, payer groups, and internal teams to meet patient and operational needs.
- High school diploma or equivalent required
- Associate’s degree or higher in an allied health or related field preferred
- Working knowledge of medical terminology and CPT coding preferred
- Strong data entry and typing skills
- Basic computer proficiency
- Excellent customer service and communication skills
- Minimum of 2 years of experience in a healthcare setting such as a hospital, physician office, or managed care organization preferred
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