"Alerted.org

Be Part of an Extraordinary Team

_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._

Referral Specialist III/Patient Access (Pre & Prior Authorizations, Appeals, Insurance) - Paragon Infusion

**Location:** 3033 W President George Bush Hwy., STE 100, Plano, TX 75075

**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 in the Plano, TX office. Virtual work is allowed on Mondays and Fridays after the training and acclimation period.

**Onsite Training:** Training will be in-person, full-time (Monday - Friday), 8 AM - 5 PM or 8:30 AM - 5:30 PM, for roughly the first five (5) weeks/30 days at the Plano, TX office.

The **Referral Specialist III** 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:

+ Providing technical guidance to Referral Specialists assist callers with issues concerning contract and benefit eligibility for requested continuing pre-certification and prior authorization of inpatient and outpatient services outside of initial authorized set.

+ Handling escalated and unresolved calls from less experienced team members.

+ Training and/or Precepting Associates to deliver and enhance the ability to serve callers.

+ Auditing the performance of Referral Specialists, assisting in the review of audit appeals and documenting audit statistics.

+ 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 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 a HS diploma or equivalent and a minimum of 3 years of experience in customer service experience in healthcare related setting; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities, & Experiences:

+ 4 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 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. 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 [email protected] 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.