Health Plan Referral Specialist at Christus Health

Posted in Other 26 days ago.

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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.

MAJOR RESPONSIBILITIES:

* 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

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled