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Referral Specialist I, IILocation: 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/hrLocations: California; New YorkIn 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.