Referral Specialist II

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Referral Specialist II

Location : Virtual - This role enables associates to work virtually full-time with the exception of required in-person training sessions providing maximum flexibility and autonomy. This approach promotes productivity supports work-life integration and ensures essential face-to-face onboarding and skill development. Seeking candidates in the Chicago IL and/or Los Angeles CA areas.

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 Hours : Monday - Friday 11:30am - 8pm CST (9:30am - 6pm PST) with alternating weekends and availability to work 8am - 12pm CST on Saturday & Sunday.

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 :

• 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 actions and other data 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 in a healthcare environment; or any combination of education and experience which would provide an equivalent background.

Preferred Skills Capabilities & Experiences :

• Knowledge of medical terminology plan specific guidelines; ICD-9 and CPT coding preferred.
• 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 physicians 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 $19.12 to $29.99/hr.

Locations: Illinois California

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 Companys sole discretion unless and until paid and may be modified at the Companys sole discretion consistent with the law.

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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 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.