Referral Specialist II

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

Referral Specialist II

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

Location: This role requires associates to be in-office 1-2 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. Alternate locations may be considered if candidates reside within a commuting distance from an office.

How you will make an impact:

• Acts as a first level SME, with ability beyond intake calls that include working on production oriented work, which may include physician assisting and/or special projects.
• Acts as liaison between hospital, health plans, physicians, patients, vendors and other referral sources.
• Reviews complex referrals for completeness and follows up for additional information if necessary.
• Assigns referrals to staff as appropriate.
• Verifies insurance coverage and obtains authorizations if needed from insurance plans.
• Contacts physician offices as needed to obtain demographic information or related data.
• Enters referrals, documents communications and actions in system.
• Enters referrals, documents communications, actions and other data 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.
• 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 in a healthcare environment; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• Knowledge of medical terminology and plan specific guidelines.
• ICD-9 and CPT coding.

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 associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.