Referral Specialist II - Benefit Verification- Paragon Healthcare at Elevance Health in Plano, Texas

Job Description:

Be Part of an Extraordinary Team



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.



Build the Possibilities. Make an Extraordinary Impact.




Title: Referral Specialist



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.


The Referral Specialist II is responsible for providing support to a clinical team 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.
  
  


• Assigns referrals to staff as appropriate.
  
  


• Verifies insurance coverage and obtains authorizations if needed from insurance plans.
  
  


• Contacts physician offices as needed to obtain demographic information or related data.
  
  


• Enters referrals, documents communications and actions in system.
  
  


• Enters referrals, documents communications, actions, and other data in system.
  
  

• Requires HS diploma or GED.
  
  


• 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, plan specific guidelines; ICD-9 and CPT coding preferred.