Hybrid Clinical Referrals Specialist

Elevance Health; Plano (TX); Hybrid; USD 42,000 - 60,000; Full time

Job summary

Elevance Health seeks a Referral Specialist II to support a clinical team by handling the administrative components of referrals. The role blends in-office collaboration 1–2 days weekly with flexibility for virtual work and occasional travel to nearby offices.

You will verify insurance, obtain authorizations, enter data in our systems, and coordinate with hospitals, physicians, patients, and vendors to ensure referrals are processed efficiently.

Qualifications

• HS diploma or GED and 1 year of experience in a high-volume, interactive customer service or call center in a healthcare environment, or equivalent background.
• Experience in a healthcare call center or similar setting is preferred.

Responsibilities

• Serve as a first level SME handling production and special projects.
• Liaise between hospital, health plans, physicians, patients, vendors and other referral sources.
• Review referrals for completeness and follow up for additional information as needed.
• Assign referrals to staff as appropriate.
• Verify insurance coverage and obtain authorizations from insurance plans.
• Contact physician offices to obtain demographic information or related data.
• Enter referrals and document communications and actions in the system.
• Manage multiple tasks including calls, texts, facsimiles, and electronic queues while taking notes and speaking to customers.
• Maintain focus during extended periods of sitting in a fast-paced, high-pressure environment.
• Demonstrate strong verbal and written communication skills for virtual and in-person interactions.
• Show empathy and persistence to resolve caller issues completely.
• Be proficient with digital tools to enhance productivity.
• Maintain a structured work schedule with occasional overtime or flexibility based on business needs.

Skills

SME (referrals)

Interpersonal liaison

Referral processing

Insurance verification

Authorizations

Data entry

Communications

Time management

Empathy

Digital tools

Office presence

Education

HS diploma or GED

Tools

ICD-9 coding

CPT coding

Job description

Elevance Health seeks a Referral Specialist II to support a clinical team by handling the administrative components of referrals. The role blends in-office collaboration 1–2 days weekly with flexibility for virtual work and occasional travel to nearby offices.

You will verify insurance, obtain authorizations, enter data in our systems, and coordinate with hospitals, physicians, patients, and vendors to ensure referrals are processed efficiently.