Referral specialist

Job details 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 great communication skills, the ability to multi-task, and a commitment to providing excellent service to members and providers. Must reside in the Rio Grande Valley Area (Brownsville, McAllen, Edinburgh, Mercedes, Weslaco) ...

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

Skills :

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,