Referral Specialist II (Healthcare)

Location: Plano, Texas, United States; hybrid schedule with in-office work 3 days per week. Candidates must live within a reasonable commuting distance of the posting location unless an accommodation is granted.

Company

Healthcare organization focused on improving lives and communities and simplifying healthcare.

What you will do

• Support clinical teams with the administrative components of patient referrals.
• Review complex referrals for completeness and follow up with physician offices for missing demographic or clinical information.
• Act as a liaison between hospitals, health plans, physicians, patients, vendors, and other referral sources.
• Verify insurance coverage and obtain required authorizations from insurance plans.
• Assign referrals to appropriate staff and enter referrals, communications, actions, and related data into internal systems.
• Handle calls, texts, faxes, and electronic queues while multitasking and supporting production work or special projects.

Requirements

• High school diploma or GED.
• At least 1 year of experience in high-volume, interactive customer service or call center work in a healthcare environment, or an equivalent combination of education and experience.
• Strong verbal and written communication skills for virtual and in-person interactions.
• Ability to multitask, maintain focus during extended periods of sitting, and work effectively in a fast-paced, high-pressure environment.
• Attention to detail, critical-thinking, problem-solving, empathy, and persistence in resolving caller issues.
• Ability to work from the Plano office 3 days per week and occasionally work overtime or adjust schedules based on business needs.

Nice to have

• Knowledge of medical terminology and plan-specific guidelines.
• Knowledge of ICD-9 and CPT coding.

Culture & Benefits

• Hybrid workforce strategy combining office collaboration with virtual-work flexibility.
• Paid holidays, paid time off, and incentive bonus programs where applicable.
• Medical, dental, vision, short- and long-term 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 accommodations and laws.