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Health Plan Referral Specialist

  • TX, Irving

  • 12/06/2025

  • Contract

  • Active

Job Description:

  • Job Summary
    The Health Plan Referral Specialist is responsible for processing referral authorization requests and researching problem claims or payment inquiries. This role ensures timely and accurate handling of referrals through the Managed Care System while maintaining compliance with organizational standards and delivering excellent service to patients and providers.

    Key Responsibilities
    1. Expedite the flow of authorization requests through the Managed Care System.
    2. Prepare requests for authorization of services by ensuring form completion, eligibility verification, chart availability, and benefits review.
    3. Accurately enter referral information into the computer system with a thorough understanding of correct system codes (type, status, procedure, etc.).
    4. Facilitate documentation of authorizations within the computer system.
    5. Notify patients and providers of authorization decisions and maintain accurate tracking of services.
    6. Request and print system reports to support daily tasks and track referral-based activity for management reporting.
    7. Utilize tracking systems to monitor the flow of referrals through the authorization process and measure turnaround times.
    8. Meet expectations of the applicable One CHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.

    Required Qualifications
    1. High School Diploma or equivalent.
    2. Prior experience in healthcare administration, referral processing, or managed care preferred.
    3. Strong knowledge of medical terminology and insurance authorization processes.
    4. Proficiency in computer systems and data entry with attention to detail.
    5. Excellent communication and customer service skills.
    6. Ability to work effectively in a fast-paced environment.

    Preferred Qualifications (if any)
    1. Previous experience in a health plan or managed care setting.
    2. Familiarity with EPIC or other healthcare information systems.

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