Referral Specialist I (Healthcare)

Location: Plano, Texas, United States; hybrid schedule with in-office work required three days per week on Tuesday, Wednesday, and Thursday. Candidates must live within a reasonable commuting distance unless a legally required accommodation is granted.

Company

hirify.global is a Fortune 25 healthcare company focused on improving lives and simplifying healthcare.

What you will do

• Initiate and manage clinical referrals for pre-authorization.
• Review referrals for completeness and obtain missing information from physician offices and referral sources.
• Verify insurance coverage and complete pre-authorization for CT, MRI, MRA, PET, and other imaging exams.
• Coordinate with hospitals, health plans, physicians, patients, vendors, and other referral sources.
• Respond to inbound exam requests while meeting quality and production standards.
• Enter referrals and document communications and actions in internal systems.

Requirements

• High school diploma or GED.
• At least one year of experience in a high-volume, interactive customer service or call center environment, or equivalent education and experience.
• Strong verbal and written communication, attention to detail, critical thinking, empathy, and problem-solving skills.
• Ability to multitask across calls, texts, faxes, and electronic queues while taking notes and assisting customers.
• Ability to work from the Plano office three days per week and occasionally work additional hours or adjust the schedule based on business needs.

Nice to have

• Knowledge of medical terminology, plan-specific guidelines, ICD coding, and CPT coding.
• Experience with healthcare benefit referrals, authorizations, appeals, and cost estimates.
• Healthcare commercial and government experience.
• NextGen experience.

Culture & Benefits

• Hybrid workforce strategy combining office collaboration with virtual work.
• Paid holidays, paid time off, and incentive bonus programs.
• Medical, dental, vision, disability, life insurance, and wellness benefits.
• 401(k) with company match, stock purchase plan, and financial education resources.
• COVID-19 and influenza vaccination may be required for certain patient- or member-facing roles, subject to applicable exceptions and laws.