Referral Specialist II – Paragon Infusion Centers

Elevance Health•Plano, TX

7d•Hybrid

About The Position

The Referral Specialist II is responsible for providing support to a clinical team in order to facilitate the administrative components of clinical referrals. This role acts as a first level SME, with abilities beyond intake calls that include working on production-oriented work, may include physician assisting and/or special projects. The Referral Specialist II acts as a liaison between hospital, health plans, physicians, patients, vendors, and other referral sources. They review complex referrals for completeness and follow up for additional information if necessary, and assign referrals to staff as appropriate. This role also involves verifying insurance coverage and obtaining authorizations if needed from insurance plans, and contacting physician offices as needed to obtain demographic information or related data. Referrals, communications, actions, and other data are entered into the system. Associates in this role are expected to multi-task, handling calls, texts, facsimiles, and electronic queues, while simultaneously taking notes and speaking to customers. They must be 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. Performs other duties as assigned.

Requirements

Requires HS diploma or GED and a minimum of 1 year of experience in a high-volume, interactive customer service or call center in a healthcare environment; or any combination of education and experience which would provide an equivalent background.

Nice To Haves

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 a first level SME, ability beyond intake calls that include working on production oriented work, may include physician assisting and/or special projects.
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.
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.
Performs other duties as assigned.