Health Plan Referral Specialist

Health Plan Referral Specialist

Position Type: 1 Contractor Onsite Location: Irving, TX 75039 Urgency: Immediate Need Required Education: High School Diploma or Equivalent (must submit proof)

The Health Plan Referral Specialist is responsible for processing all referral authorization requests and assisting with the resolution of problem claims, payment requests, and managed care documentation. This position requires strong knowledge of medical terminology, CPT codes, computer systems, and customer service.

This role is fully onsite in Irving, Texas.

Key Responsibilities

• Referral & Authorization Processing
• Expedite the flow of authorization requests through the Managed Care System.
• Prepare and verify authorization forms, ensuring completion and accuracy.
• Validate patient eligibility, benefits, and required documentation prior to authorization.
• Accurately enter referral and authorization details into the computer system using correct codes (type, status, procedures, etc.).
• Facilitate correct documentation of authorizations within internal systems.
• Communication & Coordination
• Notify patients and providers regarding authorization approvals, denials, or additional requirements.
• Provide professional and timely communication to internal departments, providers, and members.
• Assist with resolution of problematic referral claims or payment requests.
• Tracking, Reporting & Administrative Duties
• Maintain accurate referral tracking through system reports and internal tracking tools.
• Monitor referral movement throughout the authorization workflow to ensure turn-around compliance.
• Print and analyze system-generated reports to support daily tasks and management reporting.
• Perform administrative tasks related to claims, member services, and referral verification as needed.

Competencies

• Leader of Self: Meets performance expectations, follows guidelines, demonstrates reliability.
• Strong customer service and communication skills.
• Ability to work efficiently in fast-paced medical or managed care settings.

Required Qualifications

• High School Diploma or Equivalent (mandatory; must be submitted with candidate)
• 2+ years experience working in a hospital, physician office, or managed care setting
• Working knowledge of: Medical terminology, CPT codes, Insurance/referral authorization workflows
• Strong computer skills, typing proficiency, and familiarity with medical systems
• Experience handling insurance or referral claims processes
• Strong attention to detail and data entry accuracy

Preferred Skills

• Claims adjusting or insurance background
• Member services experience
• Experience in a healthcare insurance environment

Skills

• Healthcare
• Insurance
• Claims Adjusting
• Member Services
• Referral Coordination
• CPT / Medical Terminology
• Data Entry & Records Management