Referral Services Assistant

Elevance Health•Nashville, TN

3d•$16 - $28•Remote

About The Position

Referral Services Assistant Location: Virtual: This role enables associates to work virtually full-time with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual/ work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law Work Schedule : Monday - Friday from 8:00 am - 4:30 pm CST. The Referral Services Assistant is a key member of the Physician support team, primarily responsible for the end-to-end identification and preparation of medical cases for clinical review. This role acts as a bridge between raw patient data and the physician review team, ensuring that all cases presented for evaluation are complete, accurate, and meet specific criteria. Accurately enter final adjudication decisions, clinical determinations, and case outcomes into the system as dictated or instructed by the reviewing Physician. The Referral Services Assistant is responsible for providing support to clinical team to facilitate the administrative components of clinical referrals for case management or disease management services to include home health, nutritional counseling, etc.

Requirements

Requires a HS diploma and a minimum of 1 year of experience in a healthcare environment; or any combination of education and experience which would provide an equivalent background.

Nice To Haves

Computer proficiency and the ability to navigate Microsoft Office products, especially Excel preferred.
Strong communication and multi-tasking skills preferred
Call center experience preferred.
Health insurance or medical office experience preferred.
Schedule flexibility with the availability for overtime preferred.

Responsibilities

Initiates and manages clinical referrals for participants registered in a disease management or health program.
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.
Assigns referrals to staff.
Verifies insurance coverage and obtains authorizations from insurance plans.
Maintains database of insurance companies for verification of coverage, accepted plans, and requirements for patient eligibility.
Contacts physician offices to obtain demographic information or related data.
Enters referrals and documents communications in system.