Referral Specialist I/Patient Access - Plano
4 hours ago
Job description
Referral Specialist I/Patient Access (Pre & Prior Authorizations, Appeals, Insurance) - Paragon InfusionLocation: 3033 W President George Bush HWY., STE 100, Plano, TX 75075
Office Requirement:
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.
Schedule:
Monday - Friday, 7:00 AM - 7:00 PM Central Time, specific shifts during business hours will be discussed during the hiring process.
Tuesday, Wednesday, and Thursday are In-Office DaysMondays and Fridays are Virtual Eligible
Position Start Date:
Monday April 20, 2026
Training Schedule:
First 20 days of Employment
Training Period Hours
1st
Day Of Employment: 9:00AM - 5:00PM CST
2nd Day of Employment - End of
Training Period: 8:30AM - 5:00PM CST
Training Period Onsite Expectation
1st Week of Employment: Monday - Thursday (Onsite), Friday (Virtual Eligible)
2nd Week of Employment - End of
Training Period:
Hybrid 2; Tuesday, Wednesday, and Thursday (Onsite), Monday and Friday (Virtual Eligible)
A proud member of the Elevance Health family of companies, Paragon Healthcare brings over 20 years in providing life-saving and life-giving infusible and injectable drug therapies through our specialty pharmacies, our infusion centers, and the home setting.
The Referral Specialist I is responsible for providing support to a clinical team in order to facilitate the administrative components of clinical referrals.
Primary duties may include, but are not limited to:
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.
Ability to review and interpret clinical records to ensure the patient meets medical policy guidelines for coverage, for completeness, and performs follow-up for additional information if necessary.
Ability to initiate pre-determination, 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
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.
1 year of experience in healthcare reimbursement, billing, or patient access, with specific experience in infusion therapy strongly preferred.
Advanced knowledge of HCPCS, NDC, CPT, and ICD-10 coding for referral management is strongly preferred.
Advanced knowledge of Medicare Local Coverage Determination is strongly preferred.
Knowledge of insurance verification, pre-authorization, and claims submission process is strongly preferred.
Strong mathematical, analytical, and problem-solving skills.
Proficiency in computer skills, including electronic health record systems and Microsoft Office suite.
An associate or bachelor's degree is preferred but not required.
Ability to work independently and collaboratively.
Ability to maintain professionalism and confidentiality.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with 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.
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.
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.
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.
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