Referral Specialist I - Paragon

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

Referral Specialist I - Paragon

Location : 3033 W. President George Bush Hwy, Suite 100, Plano, TX 75075

Shift: 8:30-5p or 9-5:30 CST, Monday- Friday

Hybrid 2: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

The Referral Specialist I (US) will be responsible for providing support to a clinical team in order to facilitate the administrative components of clinical referrals.

How you will make an impact:

• 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 have the ability to multi-task, including handling calls, texts, facsimiles, and electronic queues, while simultaneously taking notes and speaking to customers.

Additional expectations to include but not limited to: Proficient in maintaining focus during extended periods of sitting and handling multiple tasks in a fast-paced, high-pressure environment; strong verbal and written communication skills, both with virtual and in-person interactions; attentive to details, critical thinker, and a problem-solver; demonstrates empathy and persistence to resolve caller issues completely; comfort and proficiency with digital tools and platforms to enhance productivity and minimize manual efforts.

Associates in this role will have a structured work schedule with occasional overtime or flexibility based on business needs, including the ability to work from the office as necessary.

Performs other duties as assigned.

Minimum Requirements:

Requires HS diploma or GED and a minimum of 1 year of experience in a high-volume, interactive customer service or call center environment; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

Medical terminology training preferred. Benefit verification/authorization.

Job Details:

Job Level: Non-Management Non-Exempt

Workshift: 1st Shift (United States of America)

Job Family: CUS > Care Support

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associate