Referral specialist

Job Description

Referral Specialist I, II

Location : This is a remote position. Ideal candidates will live within 50 miles of an Elevance Health PulsePoint office location.

A proud member of the Elevance Health family of companies, Carelon Behavioral Health, formerly Beacon Health Options, offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work / life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care.

We are looking for candidates to work on the New Jersey Crisis Line with knowledge of behavioral health social services and insurance systems, and a deep understanding of the factors that impact a person’s experiences in the mental health system, including but not limited to, race, ethnicity, gender identity, sexual orientation, language proficiency, religion, disability status, socioeconomic status, criminogenic risk, and history of trauma.

The Referral Specialist I, II is responsible for providing support to a clinical team in order to facilitate the administrative components of clinical referrals.

We operate 24 hours a day, 7 days a week, 365 days out of the year. This is a 24-hour call center, open 365 days, with varied 1st, 2nd, and 3rd shifts to include weekends.

How you will make an impact :

Referral Specialist I :

• Initiates and manages clinical referrals for pre-authorization.
• Assigns escalated referrals to staff as appropriate.
• Responds to requests following established processes, meets quality and production standards.
• Enters referrals, documents communications and actions in system
• Conducts follow-up calls or sends emails to individuals who initially reach out through the helpline in emotional distress or crisis.
• Troubleshoots barriers encountered in obtaining services.
• Reviews Safety Plan, where applicable, to ensure plans remain sufficient for current circumstances.
• Coordinates identification of and referrals to local, state or federally funded programs and agencies.
• Dispatch Mobile Crisis Teams where those services are available.
• Prepares reports and maintains the database to retain validated resources and service offerings.

Referral Specialist II :

• Acts as a first level SME, ability beyond intake calls that include working on production oriented work, may include physician assisting and / or special projects.
• Acts as liaison between hospital, health plans, physicians, patients, vendors and other referral sources.
• Reviews complex referrals for completeness and follows up for additional information if necessary.
• Assigns referrals to staff as appropriate.
• Verifies insurance coverage and obtains authorizations if needed from insurance plans.
• Contacts physician offices as needed to obtain demographic information or related data.
• Enters referrals, documents communications and actions in system.
• Enters referrals, documents communications, actions and other data in system

Minimum Requirements :

Referral Specialist I : 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.

Referral Specialist II : Requires HS diploma or GED and a minimum of 1 year experience and a minimum of 1 year of experience in a high-volume, interactive customer service or call center in a healthcare environment;

or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences :

• Experience working directly with individuals in need of behavioral health services.
• Knowledge of medical terminology preferred.
• Knowledge of plan specific guidelines; ICD-9 and CPT coding preferred for level II.

For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $17.69 to $31.30 / hr

Locations : California; New York

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.

Job Level :

Non-Management Non-Exempt

Workshift : Job Family :

Job Family : CUS >

CUS >

Care Support

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.

Last updated : 2024-07-17

Salary : $18 - $31