Referral Specialist

Anticipated End Date:

Position Title:

Referral Specialist I

Job Description:

Referral Specialist I

Location:

Hybrid 2:
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. 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.

Hours Onsite:
Associate will be assigned a shift between 11:30 AM and 8:00 PM Central time, Monday - Friday with 3 days per week on-site at 8600 Bryn Mawr Avenue, Chicago IL 60631. 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:
Validating appeal requests and initiates and manages clinical referrals for pre-authorization. Managing Appeals Live Line, voicemails and emails as assigned and acts as a liaison between hospital, health plans, physicians, patients, vendors and other referral sources. Managing and triaging mail onsite for the Bryn Mawr office and reviews referrals for completeness and follows up for additional information if necessary. Opening and closing appeal requests following established appeal processes to maintain quality, turnaround time, and compliance requirements and 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. 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. Prior healthcare experience strongly preferred. For candidates working in person or virtually in the below locations, the salary
* range for this specific position is $19.17 to $28.75. Location(s):
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…