Referral Specialist

Location: Irving, TX
Date Posted: 02-01-2019
Referral Specialist – Managed Care
Irving, TX (greater Dallas - Ft. Worth area)
*** This is a Full-Time, Benefits Available, CONTRACT assignment, expected to last around 1 month, or longer! ***

Referral Specialist Job Summary: 
  • The Referral Specialist will be processing letters for authorization decisions, calling patients to notify them of decisions, and helping process consults for clinical providers. 
  • Handles incoming requests for patient placement, referrals for new orders and refills, and/or requests for services.
  • Receives and verifies requests and referrals, initiates insurance verification and gathers all information necessary for pre-certifications, authorizations, and certificates of medical necessity, while ensuring that each patient meets admission criteria.
  • Builds referrals using information in patient medical record to provide minimum data necessary to coordinate patient services.
  • Provides verbal and written instructions to patients, families, and coordinating resources regarding provision of products and services, reimbursement and patient financial responsibility.
  • Records patient intake and insurance information and authorization requirements and notes in the computer systems.
  • Coordinates requested services, products, and referrals with pharmacy warehouse, clinical staff, as well as service and equipment providers, as appropriate.
  • Facilitates problem solving with patients, hospitals, providers, referral sources, insurance companies, and clinical staff.
  • Assists in the maintenance and communication of changing payer and referral source information specific to coordination of patient needs. 
Referral Specialist Background:  
  • Requires an education level of at least a high school diploma or GED.
  • Certified Nursing Assistant (CNA) or Medical Assistant (MA) background is highly preferred.
  • Requires at least 1 year of experience in a clinical / healthcare environment.
  • Must have a working knowledge of medical terminology and have familiarity with managed care principles.
  • Ability to multi-task duties as well as the ability to understand multiple products and multiple levels of benefits within each product.
  • Knowledge of health care delivery system, Medicaid/Medicare and related state programs is a significant plus.
  • Computer skills to include Microsoft Word, Excel and basic data entry, including the ability to learn new and complex computer system applications.
410.885.4745 (CALL – TEXT – FAX)

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