Health Plan Referral Specialist

Health Plan Referral Specialist

Position Type: 1 Contractor –Onsite
Location: Irving, TX 75039

Urgency:Immediate Need
Required Education: High School Diploma or Equivalent (must submit proof)

TheHealth Plan Referral Specialist is responsible for processing all referral authorization requests and assisting with the resolution of problem claims, payment requests, and managed care documentation. This position requires strong knowledge of medical terminology, CPT codes, computer systems, and customer service.

This role is fullyonsite in Irving, Texas.

Key Responsibilities

Referral & Authorization Processing

• Expedite the flow of authorization requests through the Managed Care System.
• Prepare and verify authorization forms, ensuring completion and accuracy.
• Validate patient eligibility, benefits, and required documentation prior to authorization.
• Accurately enter referral and authorization details into the computer system using correct codes (type, status, procedures, etc.).
• Facilitate correct documentation of authorizations within internal systems.

Communication & Coordination

• Notify patients and providers regarding authorization approvals, denials, or additional requirements.
• Provide professional and timely communication to internal departments, providers, and members.
• Assist with resolution of problematic referral claims or payment requests.

Tracking, Reporting & Administrative Duties

• Maintain accurate referral tracking through system reports and internal tracking tools.
• Monitor referral movement throughout the authorization workflow to ensure turn-around compliance.
• Print and analyze system-generated reports to support daily tasks and management reporting.
• Perform administrative tasks related to claims, member services, and referral verification as needed.

Competencies

• Leader of Self: Meets performance expectations, follows guidelines, demonstrates reliability.
• Strong customer service and communication skills.
• Ability to work efficiently in fast-paced medical or managed care settings.

Required Qualifications

• High School Diploma or Equivalent (mandatory; must be submitted with candidate)
• 2+ years experience working in ahospital, physician office, or managed care setting
• Working knowledge of:
  • Medical terminology
  • CPT codes
  • Insurance/referral authorization workflows
• Strong computer skills, typing proficiency, and familiarity with medical systems
• Experience handling insurance or referral claims processes
• Strong attention to detail and data entry accuracy

Preferred Skills

• Claims adjusting or insurance background
• Member services experience
• Experience in a healthcare insurance environment

Skills

• Healthcare
• Insurance
• Claims Adjusting
• Member Services
• Referral Coordination
• CPT / Medical Terminology
• Data Entry & Records Management

Recruiter Submission Template –

Full Name:
Proof of Education Attached (HS Diploma or Equivalent)? (yes/no):
Highest Education Completed:

Do you have at least 2 years of experience in a hospital, physician office, or managed care organization? (yes/no):
Experience processing authorizations and referrals? (yes/no):
Experience with CPT codes and medical terminology? (yes/no):
Insurance claims or member services experience? (yes/no):
Experience researching or resolving problem referral claims? (yes/no):

Ability to work onsite full-time in Irving, TX? (yes/no):
Reliable, detail-oriented, able to maintain accuracy? (yes/no):

Availability for Interview:
Contact Number:
Email ID:
LinkedIn Profile URL:
Full Address (Street, City, State, Zip):
Notice Period (in weeks):
Current Work Authorization Status:
Expected Hourly Rate (W2):
Earliest Interview Availability:
Earliest Start Date:

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