Referral Specialist II / Patient Access (Pre & Prior Authorizations, Appeals, Insurance) Paragon Infusion

Elevance Health•Plano, TX

1d•Hybrid

About The Position

A proud member of the Elevance Health family of companies, Paragon Healthcare brings over 20 years in providing life-saving and life-giving infusible and injectable drug therapies through our specialty pharmacies, our infusion centers, and the home setting. The Referral Specialist II 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 (Tuesdays, Wednesdays, and Thursdays), 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. The training schedule for the first 20 days involves a mix of onsite and virtual days, with the first week being mostly onsite.

Requirements

HS diploma or GED.
Minimum of 1 year of experience in a high-volume, interactive customer service or call center in a healthcare environment; or any combination of education and experience which would provide an equivalent background.
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

Benefit verification and authorization experience.
Knowledge of HCPCS, NDC, CPT, and ICD-10 coding for referral management.
Knowledge of Medicare and Local Coverage Determination.
Knowledge of insurance verification, pre-authorization, and claims submission process.
Strong analytical, and problem-solving skills.
Proficiency in computer skills, including electronic health record systems and Microsoft Office suite.
Ability to work independently and collaboratively.
Ability to maintain professionalism and confidentiality.

Responsibilities

Acts as a first level SME, ability beyond intake calls that include working on production oriented work, may include physician assisting and/or special projects.
Acts as liaison between hospital, health plans, physicians, patients, vendors and other referral sources.
Reviews complex referrals for completeness and follows up for additional information if necessary.
Assigns referrals to staff as appropriate.
Verifies insurance coverage and obtains authorizations if needed from insurance plans.
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.