WARNING: Please beware of phishing scams that solicit interviews or promote work-at-home opportunities, some of which may pose as legitimate companies. Elevance Health requires a completed online application for consideration of employment for any position. We will never ask you for a credit card, send you a check, or ask you for payment as part of consideration for employment.

　　Referral Specialist I

　　Job Family: Customer Care

　　Type: Full time

　　Date Posted:Jan 23, 2024

　　Anticipated End Date:Mar 22, 2024

　　Reference: JR102066

　　Location:

　　CA, CERRITOS

　　PA, SEVEN FIELDS

　　VA, ARLINGTON

　　FL, MIAMI

　　MA, BOSTON

　　IN, INDIANAPOLIS

　　OH, CINCINNATI

　　NY, NEW YORK

　　CT, ROCKY HILL

　　CA, RANCHO CORDOVA

　　MI, WIXOM

　　TN, BRENTWOOD

　　DC, WASHINGTON

　　MD, ANNAPOLIS

　　NV, LAS VEGAS

　　MN, MENDOTA HEIGHTS

　　TN, KNOXVILLE

　　MO, SPRINGFIELD

　　MO, COLUMBIA

　　VA, ASHBURN

　　OH, COLUMBUS

　　NC, CARY

　　WA, LAKEWOOD

　　WI, MADISON

　　WV, CHARLESTON

　　NE, LINCOLN

　　DE, WILMINGTON

　　NE, OMAHA

　　OH, SEVEN HILLS

　　ID, MERIDIAN

　　ID, MERIDIAN

　　RI, SMITHFIELD

　　NC, WINSTON

　　GA, ATLANTA

　　DC, WASHINGTON

　　IL, DEERFIELD

　　VA, RICHMOND

　　FL, TAMPA

　　FL, ALTAMONTE SPRINGS

　　FL, TALLAHASSEE

　　KS, TOPEKA

　　VA, ROANOKE

　　CO, COLORADO SPRINGS

　　FL, JACKSONVILLE

　　CA, WOODLAND HILLS

　　WI, Waukesha

　　NJ, MORRISTOWN

　　MO, JEFFERSON CITY

　　TN, MEMPHIS

　　OH, MASON

　　NY, ALBANY

　　CA, SACRAMENTO

　　CA, WALNUT CREEK

　　PA, HERMITAGE

　　KY, LOUISVILLE

　　WA, SEATTLE

　　NH, MANCHESTER

　　TX, GRAND PRAIRIE

　　IL, CHICAGO

　　TX, AUSTIN

　　MI, DEARBORN

　　VA, CHESAPEAKE

　　TN, NASHVILLE

　　MN, GILBERT

　　LA, METAIRIE

　　NY, MIDDLETOWN

　　AR, LITTLE ROCK

　　IL, SPRINGFIELD

　　GA, MIDLAND

　　TX, HOUSTON

　　VA, NORFOLK

　　CA, LOS ANGELES

　　CT, WALLINGFORD

　　MO, ST LOUIS

　　CA, COSTA MESA

　　MD, HANOVER

　　NJ, ISELIN

　　OH, MASON

　　IL, CHICAGO

　　CO, DENVER

　　NV, LAS VEGAS

　　CA, PALO ALTO

　　ME, SOUTH PORTLAND

　　NY, LATHAM

　　OH, COLUMBUS

　　GA, AUGUSTA

　　IA, W DES MOINES

　　MA, WOBURN

　　MA, NEWTON 55 CHAPEL ST

　　Description

　　Referral Specialist I

　　Location: Remote, within 50 miles of an Elevance pulse point

　　Hours: Monday - Friday, from 9:30 am - 6:00 pm PST , with a monthly rotating weekend requirement of Saturday and Sunday from 6 am - 10 am PST .

　　A proud member of the Elevance Health family of companies, Carelon Post Acute Solutions, formerly myNEXUS, is the leader in health resource optimization, focused on transforming how healthcare is delivered and promoting the advancement of care for the people we serve. 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

　　For candidates working in person or remotely in the below locations, the salary* range for this specific position is $16.19 to $29.15

　　Locations : California; Colorado; Hawaii; Nevada; New York; Washington State; Jersey City, NJ

　　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 Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.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 [email protected] for assistance.

　　EEO is the Law

　　Equal Opportunity Employer / Disability / Veteran

　　Please use the links below to review statements of protection from discrimination under Federal law for job applicants and employees.

　　EEO Policy Statement

　　Know Your Rights

　　Pay Transparency

　　Privacy Notice for California Residents

　　Elevance Health, Inc. is anE-verify Employer (https://www.e-verify.gov/sites/default/files/everify/posters/EVerifyParticipationPoster.pdf)

　　Need Assistance?

　　Email us ([email protected])