We are seeking a detail-oriented and customer-focused Referral Specialist to support our healthcare coordination efforts. This role is responsible for processing referrals and prior authorizations, ensuring members receive the necessary care while maintaining cost-effectiveness. The ideal candidate will have strong communication skills, the ability to multi-task, and a commitment to providing excellent service to members and providers.
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Responsibilities:
Process and manage referrals, prior authorizations, and pre-certifications for medical services.
Coordinate with providers, members, and internal departments to ensure timely access to healthcare services.
Verify eligibility and benefits coverage to determine appropriate referral approvals.
Review medical documentation for accuracy and compliance with company policies.
Reconcile claims and resolve referral-related issues in a timely manner.
Maintain accurate records and documentation within the system.
Educate members and providers on referral procedures and coverage guidelines.
Ensure compliance with company policies, state regulations, and healthcare standards.
Working hours: 8:00 AM - 5:00 PM (Various Shifts Available)
Skills:
Strong organizational and problem-solving abilities.
Excellent customer service and communication skills.
Proficiency in medical terminology, insurance policies, and prior authorization procedures.
Familiarity with healthcare software and electronic medical records (EMR).
Ability to work independently and as part of a team.
Education:
High School
Experience:
1-4 years
Qualifications:
Education: High school diploma or GED required; associate?s or bachelor?s degree in healthcare administration or a related field preferred.
Experience: At least 1-2 years of experience in a healthcare setting, preferably in medical referrals, authorizations, or insurance verification.
Must reside in Brownsville Texas, or McAllen, Texas area
If you're ready to bring your skills and passion to a mission-driven company, apply now and take the next step in your career!
Spherion has helped thousands of people just like you find work happiness! Our experienced staff will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temp-to-perm or direct hire opportunities, no one works harder for you than Spherion.
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.
At Spherion, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact Callcenter@spherion.com.
Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Spherion offers a comprehensive benefits package, including health, and an incentive and recognition program (all benefits are based on eligibility).