Health Plan Referral Specialist

Job Title : Health Plan Referral Specialist

Location : Irving, TX (Onsite)

Job Type : Contract

Hours : Monday - Friday, 9 : 00 AM to 5 : 00 PM

Pay Rate : $18.13 / hr

NOTE : We will consider only U.S. citizens and Green Card holders.

Summary :

We are seeking a detail-oriented and organized Health Plan Referral Specialist to join our team. The ideal candidate will have experience in a hospital, physician office, or managed care setting and will be responsible for processing referral authorizations, managing claims, and ensuring accurate documentation in compliance with company policies.

Responsibilities :

Expedite the flow of referral authorization requests through the managed care system.

Prepare and process service authorization requests, ensuring forms are complete and eligibility, benefits, and charts are verified.

Accurately enter referral information into the computer system, including type, status, and procedure codes.

Document authorizations and maintain tracking for all services.

Notify patients and providers of authorization decisions.

Generate system reports to monitor referral activities and support management reporting.

Research and resolve problem referral claims or requests for payment.

Utilize tracking systems to monitor referrals and measure processing efficiency.

Requirements :

High School Diploma or equivalent (proof of education required).

Minimum of 2 years’ experience in a hospital, physician office, or managed care organization.

Working knowledge of medical terminology and CPT codes.

Strong typing and computer skills.

Ability to accurately process and track referrals while maintaining compliance and attention to detail.

Skills : Healthcare knowledge

Insurance claims processing

Member services

Data entry and documentation

Communication and organizational skills