Referral Specialist I — Medical Pre-Auth (Hybrid)

The Elevance Health Companies, Inc.; Plano (TX); Hybrid; USD 36,000 - 48,000; Full time

Job summary

Elevance Health is hiring a Referral Specialist I – Paragon in Plano, TX. This hybrid role requires in-office presence three days a week to collaborate with care teams and coordinate referrals for pre-authorization of imaging and other services.

Responsibilities include processing referrals, verifying insurance, and communicating with hospitals, physicians, patients, and vendors. Strong multitasking, attention to detail, and empathy are essential for resolving inquiries and ensuring smooth care

Qualifications

• Requires HS diploma or GED and at least 1 year of high-volume, interactive customer service experience.
• Experience in call center or interactive customer service is preferred.
• Medical terminology training preferred.

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 following established processes.
• Responds to inbound calls initiating exam requests, meeting quality and production standards.
• Contacts physician offices to obtain demographic information or related data.
• Enters referrals, documents communications and actions in system.
• Maintains focus during extended periods of sitting and handling multiple tasks in a fast-paced environment.

Skills

Medical terminology

Customer service

Education

HS diploma or GED

Job description

Elevance Health is hiring a Referral Specialist I – Paragon in Plano, TX. This hybrid role requires in-office presence three days a week to collaborate with care teams and coordinate referrals for pre-authorization of imaging and other services.

Responsibilities include processing referrals, verifying insurance, and communicating with hospitals, physicians, patients, and vendors. Strong multitasking, attention to detail, and empathy are essential for resolving inquiries and ensuring smooth care