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Referral Specialist II (US)

  • Job Family: Customer Care
  • Type: Full time
  • Date Posted:
  • Req #: JR15464

Location:

  • NV, Las Vegas
  • Indiana, Indiana
  • MO, St. Louis
  • Georgia, Georgia
  • Colorado, Colorado
  • National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint

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Description

Responsible for providing support to a clinical team in order to facilitate the administrative components of clinical referrals for various AIM services.

 Primary duties may include, but are not limited:

  • 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.

Requirements:

  • Requires HS diploma or GED and a minimum of 1 year experience 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.  
  • This position is part of our FGS (Federal Government Services) division which, per CMS TDL 190275, requires foreign national applicants meet the residency requirement of living in the United States at least three of the past five years.

Preferred Skills, Capabilities, and Experiences:

  • Knowledge of medical terminology, plan specific guidelines; ICD-9 and CPT coding preferred.

Applicable to Colorado Applicants Only

Hourly Pay Range*: $17.49/hr - $21.86/hr (Min – MRP) 

Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. 

* The hourly or 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.  The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future.  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 from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Be part of an Extraordinary Team

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

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.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealthinc.com. 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 ability@icareerhelp.com for assistance.

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