A proud member of the Elevance Health family of companies, Paragon Healthcare brings over 20 years in providing life-saving and life-giving infusible and injectable drug therapies through our specialty pharmacies, our infusion centers, and the home setting.
Title: Referral Specialist II - Patient Access
Location: 3033 W President George Bush Hwy Suite 100A, Plano, TX 75075
Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
Work Shift Hours: Monday through Friday, 8 hour shift
Anytime between the business hours of 7:00am to 7:00pm (CST).
The Referral Specialist II is responsible for providing support to a clinical team in order to facilitate the administrative components of clinical referrals.
How you will make an impact:
Primary duties may include, but are not limited to:
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.
Contacts physician offices as needed to obtain demographic, and clinical information or related data.
Review and interpret clinical records to ensure patient meets medical policy guidelines for coverage.
Verify insurance coverage, determines OOP, and obtains authorization or pre-determination for medical and pharmacy payers through multiple methods for specialty chronic and acute therapy services.
Initiate appeal for front end denials based on payer policy.
Enters referrals, documents communications, actions, and other data in system.
Minimum 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.
