Referral Specialist I

Elevance Health•Nashville, TN

1d•Remote

About The Position

The Referral Specialist is responsible for providing support to a clinical team in order to facilitate the administrative components of clinical referrals. This role enables associates to work virtually full-time, with the exception of required in-person training sessions (when indicated), providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law.

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

Knowledge of medical terminology preferred.

Responsibilities

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.