Referral Specialist I - Paragon Healthcare

Anticipated End Date:

2025-12-01

Position Title:

Referral Specialist I - Paragon Healthcare

Job Description:

A proud member of the Elevance Health family of companies, Paragon Healthcare brings over 20 years in providing life-saving and life-giving infusible and injectable drug therapies through our specialty pharmacies, our infusion centers, and the home setting.

Referral Specialist I

Location: TX-PLANO, 3033 W PRESIDENT GEORGE BUSH HWY, STE 100

Schedule: Monday-Friday; Central Time Zone

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. Alternate locations may be considered if candidates reside within a commuting distance from an office.

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 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: 

• 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.

• 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.

• Enters 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: 

• Knowledge of medical terminology preferred.

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 sub