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

About the position Referral Specialist I/Patient Access (Pre & Prior Authorizations, Appeals, Insurance) - Paragon Infusion 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. 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 Responsibilities • 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 the 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. 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. Nice-to-haves • 1 year 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. Benefits • 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. Apply tot his job Apply To this Job