Referral Specialist III – Paragon

Elevance Health•Plano, TX

13d•Hybrid

About The Position

The Referral Specialist III is responsible for issues involving precertification and prior authorization review. In addition to the duties of Referral Specialist I and II, this role provides technical guidance to Referral Specialists and helps callers with contract and benefit eligibility questions for continuing precertification and prior authorization of inpatient and outpatient services beyond the initially authorized set. The specialist handles escalated and unresolved calls, trains or precepts associates, audits Referral Specialist performance, assists with audit appeals, and documents audit statistics. The role requires multitasking across calls, texts, faxes, and electronic queues while taking notes and speaking with customers. Associates are expected to maintain focus while sitting for extended periods and working in a fast-paced, high-pressure environment; communicate effectively in virtual and in-person interactions; demonstrate attention to detail, critical thinking, problem-solving, empathy, and persistence; and use digital tools and platforms proficiently. The schedule is structured, with occasional overtime or flexibility based on business needs and the ability to work from the office as necessary. This hybrid role is based in Plano, Texas, and requires associates to work in the office three days per week. Candidates must live within a reasonable commuting distance unless an accommodation is granted as required by law.

Requirements

High school diploma or equivalent, and at least 3 years of customer service experience in a healthcare-related setting; or an equivalent combination of education and experience.
Ability to multitask in a fast-paced, high-pressure environment and maintain focus while sitting for extended periods.
Strong verbal and written communication skills for 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 with digital tools and platforms.
Ability to work occasional overtime or adjust schedule based on business needs, and to work from the office as necessary.
Ability to commute to the Plano, Texas location and work onsite three days per week, unless an accommodation is granted as required by law.

Nice To Haves

Medical terminology training.
Benefit verification or authorization experience.
Mentoring experience.

Responsibilities

Provide technical guidance to Referral Specialists and assist callers with contract and benefit eligibility issues for continuing precertification and prior authorization of inpatient and outpatient services beyond the initial authorized set.
Handle escalated and unresolved calls from less experienced team members.
Train and/or precept associates to improve their ability to serve callers.
Audit Referral Specialists’ performance, assist with the review of audit appeals, and document audit statistics.
Handle calls, texts, facsimiles, and electronic queues while taking notes and speaking with customers.
Perform other duties as assigned.