Referral Specialist III – Paragon

Elevance Health•Plano, TX

14d•Hybrid

About The Position

The Referral Specialist III (US) handles issues involving precertification and prior authorization review. The role includes the duties of Referral Specialist I and II, along with providing technical guidance and handling escalated and unresolved caller issues related to contract and benefit eligibility for continuing precertification and prior authorization of inpatient and outpatient services beyond the initial authorized set. This position trains or precepts associates, audits Referral Specialists’ performance, assists with audit appeals, and documents audit statistics. Associates manage calls, texts, facsimiles, and electronic queues while taking notes and communicating with customers. The role requires maintaining focus while seated for extended periods and working across multiple tasks in a fast-paced, high-pressure environment. The position has a structured schedule, with occasional overtime or flexibility based on business needs and the ability to work from the office as necessary. The position is based in Plano, Texas, under a Hybrid 2 arrangement requiring three in-office 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.
Strong verbal and written communication skills for virtual and in-person interactions.
Ability to multitask and maintain focus during extended periods of sitting 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 to improve productivity and minimize manual work.
Ability to work occasional overtime or adjust schedule based on business needs, and to work from the office as necessary.

Nice To Haves

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

Responsibilities

Provide technical guidance to Referral Specialists assisting callers with contract and benefit eligibility issues for continuing precertification and prior authorization of inpatient and outpatient services outside 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 the performance of Referral Specialists.
Assist in reviewing 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.