Referral Specialist II – Paragon Home Infusion

Elevance Health•Nashville, TX

8d•Remote

About The Position

The Referral Specialist II - Paragon Home Infusion is responsible for providing support to a clinical team in order to facilitate the administrative components of clinical referrals. This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. 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. 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.

Requirements

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

Nice To Haves

Specialty Pharmacy experience.
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

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.
Enters referrals, documents communications, actions and other data in system.
Performs other duties as assigned.