Remote
Referral Specialist I
Location : Remote/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. The office is located at 8600 W. Bryn Mawr Ste. 800, Chicago, IL.
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 and accommodating is granted as required by law.
Work Schedule : Monday - Friday 10:30 am - 7:00 pm CST
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 for radiology and other imaging exams (CT, MRI, MRA, PET, et.) following established process and procedures.
- 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.
- Validating appeal requests
- Managing Appeals Live Line, voicemails and emails as assigned
- Opening and closing appeal requests following established appeal processes to maintain quality, turnaround time, and compliance requirements.
- Outreach to providers with appeal process instructions
- Notifying providers of appeal decisions
- Maintain personal log all appeal requests assigned to ensure completion, as needed.
- Team communication.
- 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 & Experiences :
- Knowledge and/or experience in medical terminology is preferred.
- Experience working with MS Excel, MS Outlook, and MS PowerPoint.
- Ideal candidate will have solid typing skills and familiarity with computer systems with an average typing speed of 45+ WPM preferred.
- Prior experience in a high-volume, interactive customer service or call center environment is preferred, specifically in a hospital, physician's office, or medical clinic environment.
- Experience in insurance pre-authorizations is strongly preferred.
- Able to navigate technology/multiple platforms and applications.
- Ability to communicate professionally, verbal and written, with nurses, physicians, leadership, and customers.
- Demonstrated ability to operate independently and as part of a team to follow directives.
- Ability to multi-task.
- Commitment to quality and excellence.
For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $18.54 to $27.81/hr.
Location: Illinois
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
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 may contact elevancehealthjobssupport@elevancehealth.com for assistance.
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.
