Referral Specialist I

Elevance Health • Nashville, TN

3d • $18 - $28 • Remote

About The Position

Referral Specialist I Location: Virtual (IN, IL, TN, TX, NV, PA, or VA), 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 Hours: Monday - Friday from 8:30 am - 5:00 pm CST The Referral Specialist 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: 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. Associates in this role are expected to have the ability to multi-task, including handling calls, texts, facsimiles, and electronic queues, while simultaneously taking notes and speaking to customers. Additional expectations to include but not limited to: Proficient in maintaining focus during extended periods of sitting and handling multiple tasks in a fast-paced, high-pressure environment; strong verbal and written communication skills, both with virtual and in-person interactions; attentive to details, critical thinker, and a problem-solver; demonstrates empathy and persistence to resolve caller issues completely; comfort and proficiency with digital tools and platforms to enhance productivity and minimize manual efforts. Associates in this role will have a structured work schedule with occasional overtime or flexibility based on business needs, including the ability to work from the office as necessary. Performs other duties as assigned.

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.
• Associates in this role are expected to have the ability to multi-task, including handling calls, texts, facsimiles, and electronic queues, while simultaneously taking notes and speaking to customers.
• Proficient in maintaining focus during extended periods of sitting and handling multiple tasks in a fast-paced, high-pressure environment
• Strong verbal and written communication skills, both with virtual and in-person interactions
• Attentive to details, critical thinker, and a problem-solver
• Demonstrates empathy and persistence to resolve caller issues completely
• Comfort and proficiency with digital tools and platforms to enhance productivity and minimize manual efforts
• Associates in this role will have a structured work schedule with occasional overtime or flexibility based on business needs, including the ability to work from the office as necessary.

Nice To Haves

• Knowledge of medical terminology preferred.
• Strong verbal and written communication skills 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.
• Performs other duties as assigned.

Benefits

• Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
• 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