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Req. No

20041

Job Title

Health Plan Referral Specialist

Market

CHRISTUS System Office

Category

General Operations

Facility

CHRISTUS Corp Irving Offices 919 and 909 Buildings

Address

919 Hidden Ridge
Irving, TX  75038
USView Other Locations

Type

FULL TIME

Apply Now Health Plan Referral Specialist Job in Irving

Summary:

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

Requirements:

  • 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

Work Type: 

Full Time


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