Referral Specialist II - Patient Access

Elevance Health•Plano, TX

1d•Hybrid

About The Position

The Referral Specialist II - Patient Access supports a clinical team by facilitating the administrative components of clinical referrals. The role serves as a first-level subject matter expert and handles production-oriented work beyond intake calls, which may include physician assistance and special projects. It acts as a liaison among hospitals, health plans, physicians, patients, vendors, and other referral sources. The specialist reviews complex referrals for completeness, follows up for missing information, assigns referrals to staff as appropriate, verifies insurance coverage, and obtains authorizations when needed. The role also contacts physician offices for demographic or related information and enters referrals, communications, actions, and other data into the system. Associates must be able to multitask across calls, texts, faxes, and electronic queues while taking notes and speaking with customers. The role requires maintaining focus during extended periods of sitting and working in a fast-paced, high-pressure environment. The schedule is structured, with occasional overtime or flexibility based on business needs, and associates may need to work from the office as necessary. The position is hybrid, requiring three in-office days per week—Tuesday, Wednesday, and Thursday—at the Plano, Texas location. Applicants must live within a reasonable commuting distance unless an accommodation is granted as required by law.

Requirements

High school diploma or GED, and at least 1 year of experience in a high-volume, interactive customer service or call center in a healthcare environment; or an equivalent combination of education and experience.
Strong verbal and written communication skills for virtual and in-person interactions.
Ability to multitask and maintain focus while sitting for extended periods in a fast-paced, high-pressure environment.
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 to enhance productivity and minimize manual work.
Ability to follow a structured schedule and occasionally work overtime or flexibly based on business needs, including working from the office as necessary.
Ability to commute to the Plano, Texas office for required onsite days, unless an accommodation is granted as required by law.

Nice To Haves

Knowledge of medical terminology.
Knowledge of plan-specific guidelines.
Knowledge of ICD-9 and CPT coding.

Responsibilities

Provide administrative support to a clinical team to facilitate clinical referrals.
Serve as a first-level subject matter expert and perform production-oriented work beyond intake calls, potentially including physician assistance and special projects.
Act as a liaison among hospitals, health plans, physicians, patients, vendors, and other referral sources.
Review complex referrals for completeness and follow up to obtain additional information when necessary.
Assign referrals to staff as appropriate.
Verify insurance coverage and obtain authorizations from insurance plans when needed.
Contact physician offices to obtain demographic information or related data.
Enter referrals and document communications, actions, and other data in the system.
Handle calls, texts, faxes, and electronic queues while taking notes and speaking with customers.
Perform other duties as assigned.