Referral Specialist II - Patient Access

Elevance Health; Plano (TX); Hybrid; USD 42,000 - 56,000; Full time

Job summary

Elevance Health in Plano, TX is seeking a Referral Specialist II - Patient Access to support a clinical team by managing administrative referrals, verifying insurance, and coordinating with physicians, patients and health plans. This role emphasizes accuracy, empathy, and timely processing.

The position operates in a hybrid model with in-office days on Tuesday, Wednesday and Thursday, promoting collaboration while maintaining flexibility.

Qualifications

• Requires HS diploma or GED and 1+ year of high-volume healthcare customer service.
• Experience handling referrals or clinical workflow is a plus.

Responsibilities

• Acts as first level SME and liaison between hospital, health plans, physicians, patients, vendors and other referral sources.
• Reviews complex referrals for completeness and follows up for additional information.
• Assigns referrals to staff as appropriate.
• Verifies insurance coverage and obtains authorizations as needed.
• Enters referrals and documents communications and actions in the system.
• Associates in this role must multi-task across calls, texts, faxes and electronic queues while taking notes and speaking with customers.
• Structured schedule with occasional overtime or flexibility based on business needs; may require in-office work.
• Performs other duties as assigned.

Skills

Customer service

Effective communication

Empathy and problem solving

Multi-tasking

Education

High School Diploma or GED

Job description

Referral Specialist II - Patient Access

Location: 3033 W PRESIDENT GEORGE BUSH HWY, STE 100 Plano, TX 75075

Hybrid: 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.

Onsite Days: Tuesday, Wednesday, Thursday

The Referral Specialist II - Patient Access is responsible for providing support to a clinical team in order to facilitate the administrative components of clinical referrals.

How you will make an impact:

• Acts as a first level SME, ability beyond intake calls that include working on production oriented work, 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.
• 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 Qualifications:

• 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, plan specific guidelines; ICD-9 and CPT coding preferred.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

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. Applicants who require accommodation to participate in the job application process should submit the Accessibility Accommodation Request Form and a member of the team will be in contact.

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.