Referral Specialist II, Patient Access - 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.


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.
  
  

• 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