Referral Specialist II – Paragon Home Infusion

Elevance Health•Plano, TX

1d•Remote

About The Position

The Referral Specialist II – Paragon Home Infusion provides administrative support to a clinical team to facilitate clinical referrals. This role serves as a liaison among hospitals, health plans, physicians, patients, vendors, and other referral sources; reviews complex referrals; and helps ensure referrals are complete and properly authorized. The position is primarily virtual, with required in-person training and the possibility of working from an office as needed. Candidates must live within a reasonable commuting distance of the posting location unless an accommodation is granted. The work schedule is Monday through Friday, 9:00 a.m. to 6:00 p.m. Central Time, with occasional overtime or schedule flexibility based on business needs. Associates must be able to manage multiple communication channels and tasks while maintaining focus in a fast-paced, high-pressure environment.

Requirements

High school diploma or GED and at least 1 year of experience in a high-volume, interactive customer service or call center role in a healthcare environment, or an equivalent combination of education and experience.
Ability to multitask across calls, texts, facsimiles, and electronic queues while taking notes and speaking with customers.
Ability to maintain focus during extended periods of sitting and handle multiple tasks in a fast-paced, high-pressure environment.
Ability to work occasional overtime or adjust schedules based on business needs, including working from the office as necessary.
Must be within a reasonable commuting distance of the posting location unless an accommodation is granted.

Nice To Haves

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

Responsibilities

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