Referral Specialist I – Paragon

Elevance Health•Plano, TX

6d•Hybrid

About The Position

The Referral Specialist I provides administrative support to a clinical team by facilitating clinical referrals. The role initiates and manages referrals for pre-authorization, coordinates with hospitals, health plans, physicians, patients, vendors, and other referral sources, and verifies insurance coverage and completes pre-authorization for radiology and other imaging exams such as CT, MRI, MRA, and PET. The specialist responds to inbound calls, reviews referrals for completeness, follows up for missing information, and records referrals, communications, and actions in the system. This position requires multitasking across calls, texts, faxes, and electronic queues while taking notes and speaking with customers. Associates are expected to maintain focus while sitting for extended periods and working in a fast-paced, high-pressure environment; communicate effectively in virtual and in-person interactions; demonstrate attention to detail, critical thinking, empathy, and persistence; and use digital tools effectively. The structured schedule may involve occasional overtime or flexibility based on business needs, including working from the office as necessary. The role is hybrid, based in Plano, Texas, with three days per week in the office. The listed schedule is 8:30 a.m.–5:00 p.m. or 9:00 a.m.–5:30 p.m. Central Time, Monday through Friday.

Requirements

High school diploma or GED, and at least 1 year of experience in a high-volume, interactive customer service or call center environment; or an equivalent combination of education and experience.
Ability to multitask and maintain focus during extended periods of sitting in a fast-paced, high-pressure environment.
Strong verbal and written communication skills for virtual and in-person interactions.
Attention to detail, critical thinking, and problem-solving skills.
Empathy and persistence in resolving caller issues completely.
Comfort and proficiency with digital tools and platforms.
Ability to work occasional overtime or adjust flexibility based on business needs, including working from the office as necessary.
Must be within reasonable commuting distance of the listed location unless an accommodation is granted as required by law.

Nice To Haves

Medical terminology training.
Benefit verification or authorization experience.

Responsibilities

Initiate and manage clinical referrals for pre-authorization.
Act as a liaison among hospitals, health plans, physicians, patients, vendors, and other referral sources.
Review referrals for completeness and follow up to obtain additional information when necessary.
Assign escalated referrals to staff as appropriate.
Verify insurance coverage and complete pre-authorization for radiology and other imaging exams, including CT, MRI, MRA, and PET, following established processes and procedures.
Respond to inbound calls initiating exam requests and meet quality and production standards.
Contact physician offices as needed to obtain demographic information or related data.
Enter referrals and document communications and actions in the system.
Handle calls, texts, faxes, and electronic queues while taking notes and communicating with customers.
Perform other duties as assigned.