COMPANY DESCRIPTION: Anthem, Inc. is the nation's leading health benefits company serving the needs of approximately 28 million medical members nationwide.

DESCRIPTION/RESPONSIBILITIES:

AIM Specialty Health is a specialty benefit management company that helps promote appropriate, safe and affordable healthcare services. For more than 25 years, we have been an innovator, leader and partner to payers and other risk bearing organizations that manage health outcomes and costs. With a suite of solutions, we provide value through clinical appropriateness review, provider collaboration and member engagement. Our solutions focus on today’s most complex and costly tests and treatments in radiology, cardiology, oncology, specialty drugs, sleep medicine, and other emerging clinical areas. We design and administer our solutions on behalf of 50 health plans, which support a diverse client base and over 42 million members, and engage with more than 330,000 providers throughout the US to help improve the quality of care and reduce costs.

The Referral Specialist will be responsible for providing support to a clinical team in order to facilitate the administrative components of clinical referrals for various AIM services.

 

Primary duties may include, but are not limited to:

• Initiates and manages clinical referrals for pre-authorization.
• Acts as a 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.
• Verifies insurance coverage and completes pre-authorization process for radiology and other imaging exams (CT, MRI, MRA, PET, et.) following established process and procedures.
• Responds to inbound calls initiating exam requests following established processes, meets quality and production standards.
• Contacts physician offices as needed to obtain demographic information or related data.
• Enters referrals, documents communications and actions in system.
   

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2014 Diversity Inc. magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.

REQUIRED SKILLS:

Required:

 

• High School diploma or GED
• 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.

To apply for this position, please use the following URL:

https://ars2.equest.com/?response_id=9c31465994db3c82aa12892744e4fb79