Referral Specialist III - Paragon Infusion Centers

Elevance Health•Plano, TX

7d•Hybrid

About The Position

The Referral Specialist III - Paragon Infusion Centers is responsible for issues involving the precertification and prior authorization review. This level is expected to be able to perform all of the duties the Referral Specialist I and II in addition to the following primary duties. How you will make an impact: Providing technical guidance to Referral Specialists assist callers with issues concerning contract and benefit eligibility for requested continuing pre-certification and prior authorization of inpatient and outpatient services outside of initial authorized set. Handling escalated and unresolved calls from less experienced team members. Training and/or Precepting Associates to deliver and enhance the ability to serve callers. Auditing the performance of Referral Specialists, assisting in the review of audit appeals and documenting audit statistics. 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. Strong verbal and written communication skills, both with virtual and in-person interactions; attentive to details, critical thinker, and a problem-solver. Demonstrates empathy and persistence to resolve caller issues completely; comfort and proficiency with digital tools and platforms to enhance productivity and minimize manual efforts. 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

HS diploma or equivalent
Minimum of 3 years of experience in customer service experience in healthcare related setting
Any combination of education and experience which would provide an equivalent background.
Strong verbal and written communication skills, both with virtual and in-person interactions
Attentive to details
Critical thinker
Problem-solver

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

Providing technical guidance to Referral Specialists assist callers with issues concerning contract and benefit eligibility for requested continuing pre-certification and prior authorization of inpatient and outpatient services outside of initial authorized set.
Handling escalated and unresolved calls from less experienced team members.
Training and/or Precepting Associates to deliver and enhance the ability to serve callers.
Auditing the performance of Referral Specialists, assisting in the review of audit appeals and documenting audit statistics.
Multi-tasking, including handling calls, texts, facsimiles, and electronic queues, while simultaneously taking notes and speaking to customers.
Maintaining focus during extended periods of sitting and handling multiple tasks in a fast-paced, high-pressure environment.
Demonstrating empathy and persistence to resolve caller issues completely.
Comfort and proficiency with digital tools and platforms to enhance productivity and minimize manual efforts.
Performing other duties as assigned.