Anthem Inc. Indianapolis Jobs

Job Information

Anthem, Inc. Referral Specialist l in Indianapolis, Indiana

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health care companies and a Fortune Top 50 Company.

Hours: Availability between 10:30 am - 7:00 pm Monday-Friday

Training: 8:00 am - 4:30pm Monday-Friday

This position is posted as a job family and the selected candidate will be placed into the job level commensurate with their experience

Referral Specialist I or II

Responsible for providing support to a clinical team in order to facilitate the administrative components of clinical referrals for various Case Management Services.

Job duties include:

  • Responds to incoming calls within in-bound call center environment requesting case management services.

  • Determines contract and benefit eligibility.

  • Verifies HIPPA, and insurance coverage for the Federal Employee Plan

  • Provides support to clinical team in order to facilitate the administrative components of clinical referrals

  • Refers cases requiring clinical review to a Nurse reviewer.

  • Acts as liaison between hospital, health plans, physicians, patients, vendors and other referral sources.

  • Reviews referrals for completeness and follows up for additional information if necessary.

  • Assigns escalated referrals to staff as appropriate.

  • Responsible for the identification and data entry of referral requests into the CM system in accordance with the plan certificate.

  • Responds to telephone and written inquiries from clients, providers and in-house departments.

  • Conducts clinical screening process.

  • Authorizes initial set of sessions to provider.

  • Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.

  • Meets Quality and Production standards following established processes and workflows.

  • Must be able to work between 10:30am - 7:00pm EST.

Qualifications

Referral Specialist l

  • High School Diploma/GED required.

  • 1-3 years of experience in a high-volume, interactive customer service or call center environment, with working knowledge of medical terminology; or any combination of education and experience, which would provide an equivalent background.

  • MS Office skills.

Referral Specialist ll

  • High School Diploma/GED required.

  • 1 year of Referral Specialist I experience; 1-3 years of experience in a high-volume, interactive customer service or call center in a healthcare environment with knowledge of medical terminology, plan specific guidelines; ICD-10 and CPT coding; or any combination of education and experience, which would provide an equivalent background.

  • Experience with FEP Direct, HRS, & ACMS preferred.

  • Experience with case management preferred.

  • Experience with NCQA preferred

  • MS Office skills.

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.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 Diversity Inc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com An Equal Opportunity Employer/Disability/Veteran

REQNUMBER: PS45765

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