Birmingham: Referral Specialist, Network Operations

HealthSpring of Alabama, Inc. is dedicated to improving the health of the community we serve by delivering the highest quality and greatest value in health care benefits and services. We are seeking a Referral Specialist in Network Operations for our Birmingham office.

Primary Function:
Responsible for the processing and data entry of referral information into the Health Plans computer documentation system.

Responsibilities:
Performs referral activities according to Health Services' established policies and procedures.
Receives referrals via telephone, fax and mail.
Verifies member eligibility using the computer system.
Enters referral information into the Health Plans computer documentation system.
Verifies Par status of providers to provide the services requested and refers non-par requests to the Medical Director.
Identifies and reports trends in non-par provider referrals to the Utilization Management Manager.
Faxes, mails or telephonically provides authorization of referrals to include authorization number, quantity of services authorized and valid timeframe for the service.
Copies, mails and certifies (as required) completed denial letters; meeting the 24-hour TAT goal.
Enters denial information into the computer documentation system.
Maintains denial letter files according to Policy and Procedure, Health Services and CMS guidelines.
Composes and types correspondence which includes but is not limited to letters, memos and reports.
Makes copies of correspondence, reports, etc. for the Utilization Management and Quality Management meetings(as required).
Maintains a file of completed referrals for a maximum of 30-days.
Attends and participates in departmental staff meetings.
Performs other duties as assigned.

Supervisory Responsibilities:
None

Job Related Skills:
Basic clerical skills (typing, word processing, data entry, etc.)
Excellent written and organizational skills
Interpersonal skills
Basic knowledge of customer service techniques
Prefer knowledge of medical terminology and ICD-9 coding

Experience:
High school diploma or equivalent
Some college preferred
One (1) year work experience in a medical environment preferred
Prefer proficiency with PC and software programs Word, Excel, Access, Power Point

HealthSpring offers a competitive salary and full range of benefits. Please remember to include Resume and salary requirements. No phone calls accepted.

Please apply via the URL: https://home.eease.com/recruit/?id=50869

HealthSpring of Alabama, Inc. is an EEO/AA employer.