Referral Specialist I - Paragon Infusion Centers

Elevance Health•Plano, TX

3d•Hybrid

About The Position

The Referral Specialist I - Paragon Infusion Centers is responsible for providing support to a clinical team in order to facilitate the administrative components of clinical referrals. This role requires associates to be in-office 3 days per week (Tuesday, Wednesday, Thursday), fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. 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 include proficiency 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; attentiveness to details, critical thinking, and problem-solving; demonstrating empathy and persistence to resolve caller issues completely; and 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

HS diploma or GED
A minimum of 1 year of experience in a high-volume, interactive customer service or call center environment
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.

Nice To Haves

Knowledge of medical terminology, plan specific guidelines; ICD and CPT coding.
Experience with healthcare benefit referrals, authorizations, appeals, and cost estimates.
Healthcare Commercial and Government experience.
NextGen experience.

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.