Referral Specialist III

12 hours ago


Plano, United States Elevance Health Full time

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.

Title : Referral Specialist III - Paragon Healthcare

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

Candidates must reside within 50 miles or 1-hour commute each way of the relevant Elevance Health location.

Shift: Hybrid , Monday – Friday, 9:00am-6:00pm

Build the Possibilities. Make an Extraordinary Impact.

The Referral Specialist III is responsible for issues involving the precertification and prior authorization review. This level is expected to be able to perform all of the duties the Referral Specialist I and II in addition to the following primary duties.

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.

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 and Experiences:

Medical terminology training preferred.

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.



  • Plano, Texas, United States Concentra Career Choice Full time

    Job Title: Referral Management CoordinatorAt Concentra Career Choice, we are seeking a highly skilled Referral Management Coordinator to join our team. As a Referral Management Coordinator, you will play a critical role in maintaining high standards for quality and an exceptional patient experience in accordance with Concentra's policies, procedures, and...

  • Referral Specialist II

    18 hours ago


    Plano, United States Elevance Health Full time

    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. Title: Referral Specialist II Location : Candidates must reside...


  • Plano, United States Baylor Scott & White Health Full time

    **JOB SUMMARY**The Patient Services Specialist 2 provides administrative help in a physician office, clinic or other operational area that assists patients, to ensure high quality, patient-centered care. Duties include patient relations, check-in or check-out, scheduling, insurance verification and answering phones. May assist in training and mentoring...


  • Plano, United States Baylor Scott & White Health Full time

    **JOB SUMMARY** The Patient Services Specialist 2 provides administrative help in a physician office, clinic or other operational area that assists patients, to ensure high quality, patient-centered care. Duties include patient relations, check-in or check-out, scheduling, insurance verification and answering phones. May assist in training and mentoring...


  • Plano, Texas, United States CSI Pharmacy Full time

    Job SummaryCareer Opportunities at CSI PharmacyCareer Summary:Career Summary: CSI Pharmacy's Referral Coordinators are customer service representatives who serve as the primary point of contact for new referrals. As a Referral Coordinator, you will be responsible for contacting each new referral, coordinating and managing all aspects of the patient...


  • Plano, United States Baylor Scott & White Healthcare Full time

    JOB SUMMARYThe Patient Services Specialist 2 provides administrative help in a physician office, clinic or other operational area that assists patients, to ensure high quality, patient-centered care. Duties include patient relations, check-in or check-out, scheduling, insurance verification and answering phones. May assist in training and mentoring junior...


  • Plano, Texas, United States Children's Health Full time

    Job Summary:The Pharmacy Technician III role at Children's Health is a critical position that requires a high level of expertise and independence. As a Pharmacy Technician III, you will work in specialized areas, including hazardous sterile compounding, critical care, hematology/oncology, and emergency room, and be responsible for coordinating daily...


  • Plano, United States BioTalent Full time

    About Us:Our client is a leading innovator in the medical device industry, dedicated to developing and manufacturing cutting-edge Class III implantable medical devices. We are committed to improving patient lives through our innovative solutions.Job Description:As an RA/QA Specialist, you will play a critical role in ensuring the quality and regulatory...


  • plano, United States BioTalent Full time

    About Us:Our client is a leading innovator in the medical device industry, dedicated to developing and manufacturing cutting-edge Class III implantable medical devices. We are committed to improving patient lives through our innovative solutions.Job Description:As an RA/QA Specialist, you will play a critical role in ensuring the quality and regulatory...


  • Plano, Texas, United States HCA Healthcare Full time

    We are seeking an experienced Obstetrics and Gynecology Physician to join our team at Women's Specialists of Plano.Specialization:Obstetrics and GynecologyJob Summary:We are looking for a skilled Obstetrician and Gynecologist to provide high-quality patient care in our private practice. The ideal candidate will have strong surgical skills and experience with...


  • Plano, Texas, United States Samsung Electronics Co., Ltd. Full time

    Job SummaryAs a Software Process Engineering Specialist at Samsung Electronics Co., Ltd., you will be responsible for designing, coding, and deploying new features for the GRMS portal. You will utilize REST APIs exposed by the GRMS backend to build content and device management features in the portal. Additionally, you will design, code, and deploy backend...


  • Plano, Texas, United States HCA Healthcare Full time

    About the Role:We are seeking an experienced full-time Obstetrics and Gynecology Physician to join our established private practice at Women's Specialists of Plano.Key Responsibilities:Provide high-quality patient care in Obstetrics and GynecologyDevelop and implement treatment plans for patientsCollaborate with other healthcare professionals to ensure...


  • Plano, Texas, United States Supplemental Health Care Full time

    Job Title: Cardiac Catheterization SpecialistSupplemental Health Care is seeking a skilled Cardiac Catheterization Specialist to join our team in Plano, Texas.Job Summary:We are looking for a highly motivated and experienced Cardiac Catheterization Specialist to work in a hospital setting. The ideal candidate will have a strong background in cardiovascular...


  • Plano, Texas, United States Winston Resources Full time

    Job Title: Travel Nurse ICU SpecialistWinston Resources is seeking a skilled travel nurse ICU specialist to fill a critical need in Plano, Texas.Job SummarySpecialty: ICUDiscipline: RNShift: 12 hours, nightsEmployment Type: TravelBenefitsLicense and certification reimbursement401k retirement planRetention bonusRelocation bonusSick payHoliday PayReferral...


  • Plano, Texas, United States Actalent Full time

    Pharmacy Dispensation SpecialistOverviewActalent, a global leader in engineering and sciences services and talent solutions, is seeking an experienced Pharmacy Dispensation Specialist to join our team. This role is a great opportunity for a skilled professional to work with a dynamic organization that helps visionary companies advance their engineering and...


  • Plano, Texas, United States Toyota Motor Corporation Full time

    Job Title: Security Operations Center Analyst IIIThe Security Operations Center (SOC) Analyst III role is a critical position within Toyota Motor Corporation's hybrid SOC, providing 24x7x365 coverage and responding to alerts, notifications, and communications. This role is responsible for incident response activities, supporting daily operations, security,...


  • Plano, Texas, United States Skyline Med Staff Nursing Full time

    Job Title: Travel Nurse ICU SpecialistSkyline Med Staff Nursing is seeking a skilled Travel Nurse ICU Specialist to join our team. As a Travel Nurse ICU Specialist, you will provide high-quality patient care in a fast-paced ICU environment.About the JobSpecialty: ICU - Intensive Care UnitDiscipline: RNEmployment Type: TravelThe ideal candidate will have a...


  • Plano, Texas, United States Uniti Med Full time

    Job Title: Travel Nurse ICU SpecialistUniti Med is seeking a skilled travel nurse ICU specialist to join our team in Plano, Texas.Job Requirements:Specialty: ICU - Intensive Care UnitDiscipline: RNDuration: 13 weeksShift: 12 hours, nightsEmployment Type: TravelAs a travel nurse ICU specialist, you will have the opportunity to work with a dynamic team and...


  • Plano, Texas, United States Cross Country Allied Full time

    Job Title: Diagnostic Imaging SpecialistJob Summary:At Cross Country Allied, we are seeking a skilled Diagnostic Imaging Specialist to work in a dynamic healthcare environment. As a Diagnostic Imaging Specialist, you will use advanced imaging technologies to capture high-quality medical images for diagnostic purposes. Working in a hospital, outpatient...


  • Plano, Texas, United States The LaSalle Group Full time

    Job Title: Patient Access SpecialistLaSalle Network is seeking a highly skilled Patient Access Specialist to join our team. As a Patient Access Specialist, you will play a vital role in ensuring seamless patient experiences by facilitating the registration process, verifying insurance information, and coordinating patient appointments.Responsibilities:Greet...