Bishop Daniel Ivancho appointed Elko in 1954 as the Rector of St. John the Baptist Byzantine Catholic Cathedral. Yet just three months later, Ivancho abruptly resigned as bishop, and the Holy See directed Elko, as the Vicar General of the Exarchate, to administer it. On February 16, 1955, Archbishop Amleto Giovanni Cicognani, the Vatican's delegate to the United States, announced that Elko would be elevated to the episcopacy. On March 6, 1955, he was ordained as Bishop at St. Peter's Basilica in Rome, Italy, by Cardinal Eugène-Gabriel-Gervais-Laurent Tisserant, Dean of the College of Cardinals and the Secretary of the Congregation for the Oriental Churches.