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Health Plan Referral Specialist at CHRISTUS Health

Posted in Other 30+ days ago.

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Type: Full Time
Location: Irving, Texas

Job Description:


This position is responsible for the coordination of Referral/Precertification Management information between the UM/CM Department and providers via telephone and/or faxed clinical information. This position also performs selected data entry as submitted by medical providers.


- Receive, process and complete data entry of demographic information for all referral and authorization requests from providers via fax or phone and as appropriate, forward to precertification nurse/care manager/case manager.

- Begin on-line process utilizing skills of typing, medical terminology and ICD/CPT coding.

- Request, document and forward out of network provider demographic information to PR Department and update case when appropriate

- Using internal scripts, process auto-approve requests per department procedures

- Begin on-line process of above, utilizing skills of typing, medical terminology, and ICD/CPT coding

- Coordinate daily review activity for on-site case managers

- Data entry of daily census, INN emergency room logs, and designated referrals/authorizations per management directive

- Assist in maintaining files for department

- Providing backup coverage for Staff Support Assistant

- Scan electronically attach notes and notify appropriate staff for follow up

- Adhere to URAC, NCQA and other regulator standards

- Communication, Collaboration and Coordination with all customers, internal and external

- Collaborate with and maintain open communication with all other departments as appropriate and required to facilitate completion of tasks/goals

- Follows the CHRISTUS Guidelines related to the Health Insurance Portability and Accountability ACT (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI)

- Attend monthly departmental meetings and/or interdepartmental meetings as appropriate

- Ability to sit for long periods of time.

- Ability to organize and prioritize work to meet deadlines.

- Ability to work occasional long or irregular hours.

- Good speaking ability, judgment, and initiative

- Ability to work a flexible work schedule including evenings and weekends


- High school diploma

- Working Knowledge of Medical terminology and CPT background

- Good typing skills

- Basic knowledge of computers

- Excellent customer service skills

- Works well with diverse groups of individuals

- Minimum of two years in related working environment such as hospital, physician office, or managed care organization

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