Hybrid Referral Specialist III - Health Services Expert

The Elevance Health Companies, Inc.; Plano (TX); Hybrid; USD 42,000 - 64,000; Full time

Job summary

Elevance Health is seeking a Referral Specialist III – Paragon in Plano, TX. The role supports pre-certification and prior authorization for inpatient and outpatient services, with a hybrid in-office requirement (3 days/week) to promote collaboration and service excellence.

The role emphasizes technical guidance, mentoring, and performance auditing within a healthcare customer service context, requiring strong medical terminology and communication skills.

Qualifications

• HS diploma or equivalent with 3+ years of healthcare customer service experience.
• Familiarity with medical terminology preferred.
• Experience mentoring or training staff is a plus.

Responsibilities

• Provide technical guidance on contract and benefit eligibility for pre-certification and prior authorization.
• Handle escalated and unresolved calls from junior staff.
• Train and precept associates to improve caller service.
• Audit referral performance and document statistics.
• Multi-task across calls, texts, faxes, and electronic queues while taking notes.

Skills

Medical terminology

Benefit verification

Mentor experience

Education

High School Diploma

Job description

Elevance Health is seeking a Referral Specialist III – Paragon in Plano, TX. The role supports pre-certification and prior authorization for inpatient and outpatient services, with a hybrid in-office requirement (3 days/week) to promote collaboration and service excellence.

The role emphasizes technical guidance, mentoring, and performance auditing within a healthcare customer service context, requiring strong medical terminology and communication skills.