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

Elevance Health • Plano, TX

7d • Hybrid

About The Position

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

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. How You Will Make an Impact Primary duties may include, but are not limited to: 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. 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 in a healthcare environment; or any combination of education and experience which would provide an equivalent background.

Nice To Haves

• Benefit verification and authorization experience is strongly preferred.
• Knowledge of HCPCS, NDC, CPT, and ICD-10 coding for referral management is strongly preferred.
• Knowledge of Medicare and Local Coverage Determination is strongly preferred.
• Knowledge of insurance verification, pre-authorization, and claims submission process is strongly preferred.
• 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.
• 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.
• Performs other duties as assigned.

Benefits

• We offer a range of market-competitive total rewards that include 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: Mid Level
• Education Level: High school or GED