Referral Specialist I
Elevance Health

Referral Specialist I

Location: 8600 Bryn Mawr Ave., St. 800; Chicago, IL 60631

Hours: Monday - Friday, an 8-hr shift between the hours of 7:00 am - 7:00 pm CST.

*This position is on-site*

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:

• Reviews appeals for completeness and follows up for additional information if necessary.
• Assigns escalated appeals to staff as appropriate.
• Responds to inbound calls initiating appeal requests following established processes, meets quality and production standards.
• Contacts physician offices as needed to obtain demographic information or related data.
• Enters appeals, documents communications and actions 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 environment; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• Knowledge of medical terminology.
• Experience working with MS Excel, MS Outlook, and MS PowerPoint.
• Average typing speed of 45+ WPM.
• Experience in a high-volume, interactive customer service or call center environment.
• Experience working in a hospital, physician's office, or medical clinic environment.
• Medical coding and/or medical terminology experience.
• Experience in insurance pre-authorizations.
• Solid typing skills and familiarity with computer systems.
• 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.
• Prioritization, organizational, and critical thinking skills.
• Ability to multi-task
• Commitment to quality and excellence
• Must be able to work an 8-hr shift, Monday - Friday, between the hours of 7 am - 7 pm CST.

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. Candidates must reside within 50 miles or 1-hour 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/member-facing roles to become vaccinated against COVID-19. 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 elevancehealthjobssupport@elevancehealth.com for assistance.

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