Referral Specialist II - Patient Access

Elevance Health•Plano, TX

3d•Hybrid

About The Position

The Referral Specialist II - Patient Access provides support to a clinical team by facilitating the administrative components of clinical referrals. The role serves as a first-level subject matter expert and may handle production-oriented work, physician assistance, or special projects. It serves as a liaison among hospitals, health plans, physicians, patients, vendors, and other referral sources; reviews complex referrals; verifies insurance and obtains authorizations; and records referral activity in the system. This hybrid position is based at 3033 W President George Bush Highway, Suite 100, Plano, Texas, and requires working in the office three days per week: Tuesday, Wednesday, and Thursday. Candidates must live within a reasonable commuting distance unless an accommodation is granted as required by law. The role involves a structured schedule, with occasional overtime or flexibility based on business needs and the ability to work from the office as needed. Associates must be able to manage multiple communication channels and tasks in a fast-paced, high-pressure environment while maintaining focus and providing attentive, empathetic customer support.

Requirements

High school diploma or GED, and at least one 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 communication channels and work in a fast-paced, high-pressure environment.
Ability to maintain focus during extended periods of sitting.
Strong verbal and written communication skills in virtual and in-person interactions.
Attention to detail, critical-thinking, and problem-solving skills.
Empathy and persistence in resolving caller issues completely.
Comfort and proficiency using digital tools and platforms.
Ability to work occasional overtime or adjust work arrangements based on business needs, including working from the office as necessary.
Ability to commute to the Plano office for the required onsite schedule, unless an accommodation is granted as required by law.

Nice To Haves

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

Responsibilities

Act as a first-level subject matter expert, taking on production-oriented work, physician assistance, and/or special projects.
Serve 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.