Health Plan Referral Specialist
CHRISTUS System Office
CHRISTUS Corp Irving Offices 919 and 909 Buildings
919 Hidden Ridge
Irving, TX 75038
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This position is responsible for the coordination of Referral/Precertification Management information between Utilization Management and providers via telephone and/or faxed clinical information and for data entry of Utilization Management information as submitted by on-site Case Managers and/or 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 Clerical Support staff
- Adhere to URAC 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
- Medical Terminology including procedure and diagnoses codes knowledge
- Able to adapt in a fast-paced workplace
- Referral/Authorization processes knowledge
- 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