Referral Specialist I - Paragon Healthcare at Elevance Health

Plano, Texas, United States

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Not SpecifiedCompensation

Entry Level & New GradExperience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

HS diploma or GED
Minimum of 1 year of experience in a high-volume, interactive customer service or call center environment (or equivalent combination of education and experience)
Ability to multi-task, including handling calls, texts, facsimiles, and electronic queues, while taking notes and speaking to customers
Proficient in maintaining focus during extended periods of sitting and handling multiple tasks in a fast-paced, high-pressure environment
Strong verbal and written communication skills for virtual and in-person interactions
Attentive to details, critical thinker, problem-solver with empathy and persistence
Comfort and proficiency with digital tools and platforms
Ability to work a structured schedule with occasional overtime or flexibility, including 1-2 days in-office per week (hybrid role; must be within commuting distance of office location)

Responsibilities

Initiates and manages clinical referrals for pre-authorization
Acts as a liaison between hospital, health plans, physicians, patients, vendors, and other referral sources
Reviews referrals for completeness and follows up for additional information if necessary
Assigns escalated referrals to staff as appropriate
Verifies insurance coverage and completes pre-authorization process
Responds to inbound calls initiating exam requests following established processes, meeting quality and production standards
Contacts physician offices as needed to obtain demographic information or related data
Enters referrals, documents communications and actions in system
Performs other duties as assigned

Skills

Key technologies and capabilities for this role

Referral ManagementPre-authorizationInsurance VerificationCustomer ServiceData EntryMulti-taskingHealthcare AdministrationPhysician Liaison

Questions & Answers

Common questions about this position

What is the work arrangement for this Referral Specialist role?

This is a hybrid role requiring associates to be in-office 1-2 days per week, with flexibility for virtual work otherwise. Candidates must reside within a reasonable commuting distance from the posting location(s), unless an accommodation is granted.

What are the minimum education and experience requirements?

A high school diploma or GED and a minimum of 1 year of experience in a high-volume, interactive environment are required.

What key skills are needed for the Referral Specialist position?

Key skills include the ability to multitask in a fast-paced environment, strong verbal and written communication, attention to detail, critical thinking, problem-solving, empathy, persistence, and proficiency with digital tools.

What is the salary or compensation for this role?

This information is not specified in the job description.

What makes a strong candidate for this Referral Specialist role?

Strong candidates will have experience in high-volume interactive settings, excel at multitasking under pressure, possess excellent communication skills, attention to detail, problem-solving abilities, and comfort with digital tools.

Elevance Health

Integrated health services and digital platform

About Elevance Health

Elevance Health focuses on enhancing the health of individuals throughout their lives by evolving from a traditional health benefits organization into a comprehensive health partner. The company serves over 118 million people, providing support at every stage of health through an integrated approach that addresses a wide range of health needs. Their services are backed by advanced capabilities and a digital health platform that streamlines access to care. Unlike many competitors, Elevance Health emphasizes a holistic view of health, aiming to redefine health and improve community well-being. The ultimate goal is to make health improvements accessible to everyone.

Indianapolis, IndianaHeadquarters

1944Year Founded

$309.4MTotal Funding

IPOCompany Stage

Enterprise Software, Social Impact, HealthcareIndustries

10,001+Employees

Benefits

Medical, dental, & vision insurance

401(k) + match

Paid holidays

Paid Time Off

Incentive bonus programs

Stock purchase plan

Life insurance

Wellness Programs

Financial education resources

Adoption & Surrogacy Assistance

Dependent-care Flexible Spending Account (DCFSA)

Parental Leave

Parental Transition Week

Critical Caregiving Leave

Risks

Departure of CFO John Gallina may create a gap in financial leadership.

Lawsuit against CMS over MA Star Ratings could lead to financial penalties.

CareBridge integration may face operational challenges, disrupting service delivery.

Differentiation

Elevance Health integrates whole health approach with digital health platform for comprehensive care.

Acquisition of CareBridge enhances home health services within Carelon division.

Strategic partnership with Clayton, Dubilier & Rice aims to innovate primary care delivery.

Upsides

AI integration in home health services can reduce hospital readmissions and improve outcomes.

Predictive analytics support early disease detection, aligning with Elevance's whole health approach.

Telehealth expansion offers opportunities to reach more patients remotely.

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