Health Plan Referral Specialist - Health Plan Utilization

DescriptionSummary: Processes all requests for referral authorizations and research problem referral claims or requests for payment. Responsibilities: Meets expectations of the applicable One CHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.Expedite the flow of authorization requests through the Managed Care System. Prepare requests for authorization of services by ensuring form completion, eligibility, verification, chart availability, benefits etc. Accurately enter referral information into the computer system with a thorough understanding of the correct system codes (type, status, procedure etc.) Facilitate documentation of authorizations into the computer system. Notify patients and providers of authorization decisions and maintains accurate tracking of services. Request and print various system report to perform daily tasks and to track referral based activity for management reporting purposes. Utilize tracking system to monitor the flow of referrals through the authorization process and to allow for measurement of turn around times and timely processing of referrals. Prepare requests for authorization of services by ensuring form completion, eligibility, verification, chart availability, benefits, etc. Notify all parties involved of authorization decisions to include patient, provider, requester, HMO, etc. Ensure appropriate actions have occurred such as scheduling of diagnostic appointments, requests for documentation/treatment plan etc. Distribute copies of referral to all appropriate sources (chart, provider, etc.) and accurately document activities associated with the referral in the medical file and computer system. Coordinate the initiation of specific home health services, DME services, diagnostics, etc., as directed by the nurse / physician for managed care plan members. Serve as a resource to staff and providers regarding managed care systems, HMO/PPO benefits, contracted providers, etc. Interface with HMO/PPO patients for direction through the referral process to increase an understanding of the authorization requirements mandated by the insurance plan. Promote and coordinate activities of payer agencies, groups or individuals to help provide answers and meet the needs of provider and/or patient. Assist in referral research for billing and collections process. Maintain contact with representatives of other organizations to exchange and update information on resources and services available. Requirements: High School diploma or equivalent required Associate's degree or higher in allied health professional field of study, preferred Working Knowledge of medical terminology and CPT background, preferred Good typing skills Basic knowledge of computers Excellent customer service skills Minimum of two (2) years in related working environment such as hospital, physician office, or managed care organization, preferred Work Type: Full Time EEO is the law - click below for more information:  https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12ScreenRdr.pdf We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact us at (844) 257-6925. Additional Information: - Specialty: Billing and Insurance Specialist - Location: 5101 North O Connor BoulevardIrving, Texas 75039 - Contact: About the Company: CHRISTUS Health is an international Catholic, faith-based, not-for-profit health system comprised of more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. Sponsored by the Sisters of Charity of the Incarnate Word in Houston and San Antonio and the Sisters of the Holy Family of Nazareth, the mission of CHRISTUS Health is to extend the healing ministry of Jesus Christ. To support our healthcare ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on staff who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States. EXTENDING THE HEALING MINISTRY OF JESUS CHRIST We are inspired by our mission, vision and core values to deliver compassionate, high quality health care, improving the health of the communities we serve. Above all, we are committed to providing our customers and their family members with a truly unique healing experience, one that embodies our values and respects the dignity and worth of each person. Creating a health care system that is truly excellent in all areas is an ongoing effort.