Clinical Referral Specialist I (Hybrid)

Elevance Health (Anthem); Plano (TX); Hybrid; USD 35,000 - 55,000; Full time

Benefits offered by this job

Hybrid work arrangement

Competitive benefits

Job summary

Elevance Health in Plano, TX is seeking a Referral Specialist I - Paragon to support a clinical team by handling the administrative components of referrals and pre-authorizations.

The role is hybrid, with in-office 3 days per week, offering collaboration while maintaining flexibility to support productivity, multi-tasking across calls, faxes and queues. You will verify insurance, coordinate with physicians and departments, and document interactions in the system to ensure timely referrals.

Qualifications

• Requires HS diploma or GED and 1 year of experience in a high-volume, interactive customer service or call center environment.
• Medical terminology training preferred; Benefit verification/authorization.

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 for radiology and other imaging exams (CT, MRI, MRA, PET, et.) following established process and procedures.
• Responds to inbound calls initiating exam requests following established processes, meets quality and production standards.
• Contacts physician offices as needed to obtain demographic information or related data.
• Enter referrals, documents communications and actions in system.
• Associates in this role are expected to multi-task, including handling calls, texts, facsimiles, and electronic queues, while taking notes and speaking to customers.

Skills

Customer service

Communication

Multitasking

Team liaison

Education

HS diploma or GED

Job description

Elevance Health in Plano, TX is seeking a Referral Specialist I - Paragon to support a clinical team by handling the administrative components of referrals and pre-authorizations.

The role is hybrid, with in-office 3 days per week, offering collaboration while maintaining flexibility to support productivity, multi-tasking across calls, faxes and queues. You will verify insurance, coordinate with physicians and departments, and document interactions in the system to ensure timely referrals.