Referral Specialist III - Paragon Infusion Centers

Referral Specialist III - Paragon Infusion Centers Shift : 8:00 am - 5:00 pm CT. 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 III - Paragon Infusion Centers is responsible for issues involving the precertification and prior authorization review. This level is expected to be able to perform all of the duties the Referral Specialist I and II in addition to the following primary duties. 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.  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.

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: Knowledge of medical terminology, plan specific guidelines; ICD and CPT coding. Experience with healthcare benefit referrals, authorizations, appeals, and cost estimates. Healthcare Commercial and Government experience. NextGen experience. Job Level: Non-Management Non-Exempt Workshift: Job Family: CUS > Care Support 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.

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