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Referral Specialist II, Patient Access - Paragon Healthcare

  • Job
    Full-time
    Junior Level
  • Customer Relations
    Healthcare
  • Tampa

AI generated summary

  • You need a HS diploma/GED, 1+ year in healthcare customer service, knowledge of medical terminology, ICD-10/CPT coding, and a pharmacy tech license.
  • You will manage referrals, liaise with healthcare providers, verify insurance, obtain authorizations, review clinical records, and document communications in the system.

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.
  • Knowledge of medical terminology preferred
  • Plan specific; ICD-10 and CPT coding preferred
  • Pharmacy tech license

Responsibilities

  • 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.

FAQs

What are the primary duties of a Referral Specialist II in Patient Access?

The primary duties include acting as a subject matter expert (SME), serving as a liaison between hospitals, health plans, physicians, patients, and vendors, reviewing complex referrals, contacting physician offices for information, verifying insurance coverage, and entering referrals and related data into the system.

What are the required qualifications for this position?

Candidates must have a high school 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 an equivalent combination of education and experience.

Is there a preferred knowledge or experience for this role?

Yes, preferred skills include knowledge of medical terminology, specific plan experience, familiarity with ICD-10 and CPT coding, and a pharmacy tech license.

What are the work hours for this position?

The work hours are Monday through Friday, with 8-hour shifts scheduled anytime between 7:00 am to 7:00 pm (CST).

Are there any vaccination requirements for this position?

Yes, new candidates in certain patient/member-facing roles are required to become vaccinated against COVID-19. If not vaccinated, an acceptable explanation must be provided to avoid having the offer rescinded.

Is there a specific commuting requirement for candidates?

Yes, candidates must reside within 50 miles or a 1-hour commute each way of a relevant Elevance Health location.

Do we offer additional benefits aside from a salary?

Yes, we offer a range of market-competitive total rewards, including merit increases, paid holidays, Paid Time Off, incentive bonus programs, medical, dental, vision benefits, a 401(k) with match, and wellness programs, among others.

Can I apply for this position if I need accommodations during the application process?

Yes, applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.

Is previous experience in a call center necessary for this role?

Yes, a minimum of 1 year of experience in a high-volume, interactive customer service or call center in a healthcare environment is required.

How does Elevance Health describe its company culture?

Elevance Health is creating a culture designed to advance its strategy while leading to personal and professional growth for associates, with values and behaviors that drive success for consumers, associates, communities, and the business.

Improving the health of humanity

Science & Healthcare
Industry
10,001+
Employees

Mission & Purpose

Fueled by our bold purpose to improve the health of humanity, we are transforming from a traditional health benefits organization into a lifetime trusted health partner.   Our nearly 100,000 associates serve more than 118 million people, at every stage of health. We address a full range of needs with an integrated whole health approach, powered by industry-leading capabilities and a digital platform for health.  We believe that improving health for everyone is possible. It begins by redefining health, reimagining the health system, and strengthening our communities.