Veracity Software Pvt. Ltd. · 1 month ago
Health Plan Referral Specialist
Irving, TX
Full-time
Onsite
Entry, Mid Level
2+ years expVeracity Software Pvt. Ltd. is seeking a Health Plan Referral Specialist responsible for processing referral authorization requests and resolving problem claims. The role requires strong knowledge of medical terminology and customer service skills, and it is fully onsite in Irving, Texas.
Information Technology & Services
Responsibilities
Expedite the flow of authorization requests through the Managed Care System
Prepare and verify authorization forms, ensuring completion and accuracy
Validate patient eligibility, benefits, and required documentation prior to authorization
Accurately enter referral and authorization details into the computer system using correct codes (type, status, procedures, etc.)
Facilitate correct documentation of authorizations within internal systems
Notify patients and providers regarding authorization approvals, denials, or additional requirements
Provide professional and timely communication to internal departments, providers, and members
Assist with resolution of problematic referral claims or payment requests
Maintain accurate referral tracking through system reports and internal tracking tools
Monitor referral movement throughout the authorization workflow to ensure turn-around compliance
Print and analyze system-generated reports to support daily tasks and management reporting
Perform administrative tasks related to claims, member services, and referral verification as needed
Qualification
Required
High School Diploma or Equivalent (mandatory; must be submitted with candidate)
2+ years experience working in a hospital, physician office, or managed care setting
Working knowledge of medical terminology
Working knowledge of CPT codes
Working knowledge of insurance/referral authorization workflows
Strong computer skills, typing proficiency, and familiarity with medical systems
Experience handling insurance or referral claims processes
Strong attention to detail and data entry accuracy
Preferred
Claims adjusting or insurance background
Member services experience
Experience in a healthcare insurance environment
Company
Veracity Software Pvt. Ltd.
At Veracity, if you have an idea you want to validate, a product you need to build, or an existing product that needs optimization, our teams are trained to jump in wherever needed.
51-200 employees
Funding
Current Stage
Growth StageCompany data provided by crunchbase