Referral Specialist IIPatient Access Pre Prior Authorizations Appeals Insurance - Paragon Infusion
Referral Specialist IIPatient Access Pre Prior Authorizations Appeals Insurance - Paragon Infusion
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Job Description
Anticipated End Date:
Position Title:
Referral Specialist II/Patient Access (Pre & Prior Authorizations Appeals Insurance) Paragon InfusionJob Description:
Be Part of an Extraordinary Team
A proud member of the Elevance Health family of companies Paragon Healthcare brings over 20 years in providing lifesaving and lifegiving infusible and injectable drug therapies through our specialty pharmacies our infusion centers and the home setting.
Referral Specialist II/Patient Access (Pre & Prior Authorizations Appeals Insurance) Paragon Infusion
Location: 3033 W President George Bush Hwy. STE 100 Plano TX 75075
Associates are required to live within a 50mile radius and a 1hour commute to our Paragon Healthcare Office listed above (Plano TX). Elevance Health supports a hybrid workplace model with PulsePoint sites used for collaboration community and connection.
Shift: Business hours are 7 AM 7 PM CST specific shifts within business hours will be discussed during the hiring process.
Onsite Requirement: Tuesday Wednesday and Thursday are physically inoffice. Remote/virtual work on Mondays and Fridays.
Onsite Training: Training will be inperson fulltime (Monday Friday) 8 AM 5 PM or 8:30 AM 5:30 PM for the first five 5 weeks at the Plano TX office.
The Referral Specialist II 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
Primary duties may include but are not limited to:
Acts as a SME ability beyond intake calls that include verifying eligibility and benefits for medical and pharmacy payers through multiple methods for specialty chronic and acute therapy services.
Acts as liaison between patients healthcare providers infusion centers pharmacy and billing department to address issues.
Ability to review and interpret clinical records to ensure patient meets medical policy guidelines for coverage for completeness and performs followup for additional information if necessary.
Ability to initiate predetermination prior authorizations and appeals for denials based on payer policy.
Ability to read and interpret payer contracts and payer policies to effectively manage referrals and mitigate risk of accounts receivable.
Maintain knowledge of therapies serviced by Paragon at minimum therapy and diagnosis correlation and patient information required.
Contacts physician offices as needed to obtain demographic information or related data.
Manage referrals documents communications actions and other data in the system.
Minimum Requirements:
HS diploma or GED and a minimum of 1 year of experience in a highvolume interactive customer service or call center in a healthcare environment; or any combination of education and experience which would provide an equivalent background.
Preferred Skills Capabilities & Experiences:
2 years of experience in healthcare reimbursement billing or patient access with specific experience in infusion therapy strongly preferred.
Advanced knowledge of HCPCS NDC CPT and ICD10 coding for referral management is strongly preferred.
Advanced knowledge of Medicare Local Coverage Determination is strongly preferred.
Knowledge of insurance verification preauthorization and claims submission process is strongly preferred.
Strong mathematical analytical and problemsolving skills.
Proficiency in computer skills including electronic health record systems and Microsoft Office suite.
An associate or bachelors degree is preferred but not required.
Ability to work independently and collaboratively.
Ability to maintain professionalism and confidentiality.
Job Level:
NonManagement NonExemptWorkshift:
1st Shift (United States of America)Job Family:
CUS > Care SupportPlease 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 marketcompetitive 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. Candidates must reside within 50 miles or 1hour commute each way of a relevant Elevance Health location.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/memberfacing roles to become vaccinated against COVID19 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 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.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
