Referral Specialist I – Paragon

Elevance Health•Plano, TX

5d•Hybrid

About The Position

The Referral Specialist I provides administrative support to a clinical team by facilitating clinical referrals and pre-authorizations. The role initiates and manages referral requests, verifies insurance coverage, and completes pre-authorization for radiology and other imaging exams. It serves as a liaison among hospitals, health plans, physicians, patients, vendors, and other referral sources. This position requires managing multiple communication channels and tasks in a fast-paced, high-pressure environment, while maintaining accuracy, focus, and attentive customer service. The role is hybrid, with three in-office days per week at the Plano, Texas location; candidates must be within reasonable commuting distance unless an accommodation is granted. The scheduled shift is 8:30 a.m.–5:00 p.m. or 9:00 a.m.–5:30 p.m. Central, Monday through Friday, with occasional overtime or schedule flexibility based on business needs.

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 maintain focus during extended periods of sitting and manage multiple tasks in a fast-paced, high-pressure environment.
Strong verbal and written communication skills for virtual and in-person interactions.
Attention to detail, critical-thinking ability, and problem-solving skills.
Empathy and persistence in resolving caller issues completely.
Comfort and proficiency with digital tools and platforms.

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 for 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, facsimiles, and electronic queues while taking notes and speaking with customers.
Perform other duties as assigned.