Referral Specialist I/Patient Access (Pre & Prior Authorizations, Appeals, Insurance) - Paragon Infusion (Hybrid)

Elevance Health • Plano, TX

5d • Hybrid

About The Position

Referral Specialist I/Patient Access (Pre & Prior Authorizations, Appeals, Insurance) - Paragon Infusion
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. 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

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.

Nice To Haves

• 1 year of experience in healthcare reimbursement, billing, or patient access, with specific experience in infusion therapy strongly preferred.
• Advanced knowledge of HCPCS, NDC, CPT, and ICD-10 coding for referral management is strongly preferred.
• Advanced knowledge of Medicare Local Coverage Determination is strongly preferred.
• Knowledge of insurance verification, pre-authorization, and claims submission process is strongly preferred.
• Strong mathematical, analytical, and problem-solving skills.
• Proficiency in computer skills, including electronic health record systems and Microsoft Office suite.
• An associate or bachelor’s degree is preferred but not required.
• Ability to work independently and collaboratively.
• Ability to maintain professionalism and confidentiality.

Responsibilities

• Ability beyond intake calls that include verifying eligibility and benefits for medical and pharmacy payers through multiple methods for specialty chronic and acute therapy services.
• Acts as liaison between patients, healthcare providers, infusion centers, pharmacy, and billing department to address issues.
• Ability to review and interpret clinical records to ensure the patient meets medical policy guidelines for coverage, for completeness, and performs follow-up for additional information if necessary.
• Ability to initiate pre-determination, prior authorizations, and appeals for denials based on payer policy.
• Ability to read and interpret payer contracts, and payer policies to effectively manage referrals and mitigate risk of accounts receivable.
• Maintain knowledge of therapies serviced by Paragon, at minimum, therapy and diagnosis correlation and patient information required.
• Contacts physician offices as needed to obtain demographic information or related data.
• Manage referrals, documents communications, actions, and other data in the system.

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees