Referral Specialist

$18 - $27/Yr

Elevance Health - Chicago, IL

Full-time - Entry Level

Hybrid - Chicago, IL

Insurance Carriers and Related Activities

About the position

The Referral Specialist I is responsible for providing support to a clinical team in order to facilitate the administrative components of clinical referrals. This is a hybrid position that will require you to occasionally go into our Chicago office. Candidates must live within 50 miles of an Elevance pulse point in Chicago, IL. The working hours are Monday - Friday from 11:30 am - 8:00 pm CST, with alternating weekend shifts from 8 am - 12 pm CST.

Responsibilities

• Reviews appeals for completeness and follows up for additional information if necessary.
• Assigns escalated appeals to staff as appropriate.
• Responds to inbound calls initiating appeal requests following established processes, meets quality and production standards.
• Contacts physician offices as needed to obtain demographic information or related data.
• Enters appeals, documents communications and actions in system.
• Validating appeal requests.
• Managing Appeals Live Line, voicemails and emails as assigned.
• Opening and closing appeal requests following established appeal processes to maintain quality, turnaround time, and compliance requirements.
• Outreach to providers with appeal process instructions.
• Notifying providers of appeal decisions.
• Maintain personal log all appeal requests assigned to ensure completion, as needed.
• Team communication.
• 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 environment; or any combination of education and experience which would provide an equivalent background.

Nice-to-haves

• Knowledge of medical terminology.
• Experience working with MS Excel, MS Outlook, and MS PowerPoint.
• Average typing speed of 45+ WPM.
• Experience in a high-volume, interactive customer service or call center environment.
• Experience working in a hospital, physician's office, or medical clinic environment.
• Medical coding and/or medical terminology experience.
• Experience in insurance pre-authorizations.
• Solid typing skills and familiarity with computer systems.
• Able to navigate technology/multiple platforms and applications.
• Ability to communicate professionally, verbal and written, with nurses, physicians, leadership, and customers.
• Demonstrated ability to operate independently and as part of a team to follow directives.
• Prioritization, organizational, and critical thinking skills.
• Ability to multi-task.
• Commitment to quality and excellence.

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution
• Paid holidays
• Paid Time Off
• Medical, dental, vision benefits
• Short and long term disability benefits
• Life insurance
• Wellness programs
• Financial education resources