Referral Specialist I

Anticipated End Date:
2025-01-18

Position Title:
Referral Specialist I - Patient Access

Job Description:

A proud member of the Elevance Health family of companies, Paragon Healthcare brings over 20 years in providing life-saving and life-giving infusible and injectable drug therapies through our specialty pharmacies, our infusion centers, and the home setting.

Referral Specialist I

Location: 3033 W President George Bush Hwy., STE 100, Plano, TX 75075

Shift: Office hours are between 7AM - 7PM CST, specific shifts within business hours will be discussed during the hiring process.

Onsite Requirement: Tuesday, Wednesday, and Thursday are in-office. Remote work on Mondays and Fridays.

Associates are required to live within a 50-mile radius and a 1-hour commute to one of our Elevance Health major office (PulsePoint) locations. Elevance Health supports a hybrid workplace model with PulsePoint sites used for collaboration, community, and connection.

The Referral Specialist I is responsible for providing support to a clinical team in order to facilitate the administrative components of clinical referrals.

How You Will Make an Impact

Primary duties may include, but are not limited to:
? Initiates and manages clinical referrals for pre-authorization.
? Acts as a liaison between hospital, health plans, physicians, patients, vendors and other referral sources.
? Reviews referrals for completeness and follows up for additional information if necessary.
? Assigns escalated referrals to staff as appropriate.
? Verifies insurance coverage and completes pre-authorization process for radiology and other imaging exams (CT, MRI, MRA, PET, et.) following established process and procedures.
? Responds to inbound calls initiating exam requests following established processes, meets quality and production standards.
? Contacts physician offices as needed to obtain demographic information or related data.
? Enters referrals, documents communications and actions in system.

Minimum Requirements: ? Requires HS diploma or GED and a minimum of 1 year of experience in a high-volume, interactive customer service or call center environment; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities, & Experiences:
? Knowledge of medical terminology is preferred.
? Experience in healthcare strongly preferred; benefit investigations & obtaining prior authorizations and predeterminations.

Job Level:
Non-Management Non-Exempt

Workshift:

Job Family:
CUS > Care Support

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities ? and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

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