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Healthcare Referral Manager

2 months ago

San Antonio, Texas, United States Christus Health Full time

Position Overview:

The role of the Referral Coordination Specialist is pivotal in managing the comprehensive referral workflow. This includes securing orders from healthcare providers, obtaining necessary insurance authorizations, scheduling patient appointments with participating physicians, and informing patients about their appointments. Additionally, the specialist will handle renewal authorizations in collaboration with both the physician's office and the insurance payor.

Key Responsibilities:

  • Investigate and resolve issues related to referral claims or payment requests.
  • Ensure accurate coding and diagnosis by physicians to facilitate appropriate referrals and insurance coverage.
  • Maintain an in-depth understanding of various insurance plans and patient coverage to guarantee correct billing.
  • Educate nursing staff and physicians on updates regarding insurance plans relevant to the referral and authorization processes.
  • Stay current with all CPT and ICD-9 coding standards to ensure proper referral processing.
  • Utilize clinical knowledge to effectively communicate with insurance companies regarding referrals.

Qualifications:

  • High School Diploma or equivalent is mandatory.
  • A minimum of 3 years of experience in an administrative role within a healthcare environment is required.
  • Extensive knowledge of managed care benefit plans, with at least 1 year of experience in a referral-centric clinic or physician's office.
  • Medical assistant certification from an accredited technical institution is preferred.

Employment Type:

This is a Full-Time position.

Equal Employment Opportunity:

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