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: Hybrid, 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.
Preferred Skills, Capabilities and Experiences:
Knowledge of medical terminology preferred
Plan specific; ICD-10 and CPT coding preferred
Pharmacy tech license
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.
