Referral Specialist III - Paragon

Elevance Health (Anthem); Plano (TX); Hybride; USD 25 000 - 39 000; Plein temps

Avantages offerts par ce poste

Medical insurance

401(k) matching

Paid time off

Résumé du poste

Elevance Health is seeking a Referral Specialist III for Paragon in Plano, TX. The role involves assisting with contract and benefit eligibility for continuing pre-certification and prior authorization of inpatient and outpatient services, while guiding callers and resolving issues.

You will mentor associates, audit performance, and handle escalations in a hybrid work environment with in-office days to foster collaboration.

Qualifications

• HS diploma or equivalent required.
• Minimum 3 years of healthcare customer service experience.

Responsabilités

• Provide technical guidance to Referral Specialists and assist callers with contract and benefit eligibility.
• Handle escalated calls from less experienced team members.
• Train and/or precept associates to improve service delivery.
• Audit referral specialist performance and document audit statistics.
• Multitask with calls, texts, faxes, and electronic queues while taking notes and speaking with customers.

Connaissances

Customer service

Verbal communication

Multi-tasking

Medical terminology

Formation

HS Diploma

Description du poste

Referral Specialist III - 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.

How you will make an impact:

Providing technical guidance to Referral Specialists assist callers with issues concerning contract and benefit eligibility for requested continuing pre-certification and prior authorization of inpatient and outpatient services outside of initial authorized set.

Handling escalated and unresolved calls from less experienced team members.

Training and/or Precepting Associates to deliver and enhance the ability to serve callers.

Auditing the performance of Referral Specialists, assisting in the review of audit appeals and documenting audit statistics.

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 a HS diploma or equivalent and a minimum of 3 years of experience in customer service experience in healthcare related setting; 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.
• Mentor experience.

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.

Benefits

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.

Hybrid Workforce Strategy

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.

Commitment to Associate Wellbeing

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certai