Referral Specialist II- Paragon

Elevance Health•Plano, TX

12d•Hybrid

About The Position

The Referral Specialist II provides administrative support to a clinical team to facilitate clinical referrals. The role serves as a liaison among hospitals, health plans, physicians, patients, vendors, and other referral sources. It reviews complex referrals for completeness, obtains additional information when needed, assigns referrals to staff, verifies insurance coverage, and obtains authorizations as needed. The specialist contacts physician offices for demographic or related information and enters referrals, communications, actions, and other data into the system. The position requires handling multiple communication channels and electronic queues while taking notes and interacting with customers. Associates are expected to maintain focus while sitting for extended periods and working in a fast-paced, high-pressure environment. The role requires strong communication, attention to detail, critical thinking, problem-solving, empathy, persistence, and comfort using digital tools. The schedule is 8:30 a.m.–5:00 p.m. or 9:00 a.m.–5:30 p.m. CST, Monday through Friday. This is a hybrid role requiring three in-office days per week, with occasional overtime or schedule flexibility and the ability to work from the office as needed. Other duties may be assigned.

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.
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, and problem-solving skills.
Empathy and persistence in resolving caller issues completely.
Comfort and proficiency with digital tools and platforms.
Ability to work occasional overtime or adjust schedule based on business needs, including working in the office as necessary.
Ability to work in the office three days per week; candidates must be within a reasonable commuting distance unless an accommodation is granted.

Nice To Haves

Knowledge of medical terminology and plan-specific guidelines.
ICD-9 and CPT coding knowledge.
Benefit verification experience.

Responsibilities

Act as a liaison between hospitals, health plans, physicians, patients, vendors, and other referral sources.
Review complex referrals for completeness and follow up for additional information when needed.
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.