Care Management Support Assistant - PartTime

Humana; United States; Remote; USD 38.000 - 46.000; Teilzeit

Benefits dieser Stelle

Medical benefits

Dental benefits

Vision benefits

401(k) plan

Paid time off

Company holidays

Parental leave

Disability insurance

Life insurance

Zusammenfassung

Humana seeks a part-time Care Management Support Assistant to provide non-clinical support for assessment and evaluation of members’ needs, guiding families to appropriate resources for care and wellbeing. The role performs administrative tasks, reviews referrals, verifies benefits, and coordinates care with providers while upholding HIPAA and confidentiality.

Requirements include 1–3 years in Home Health or Infusion Pharmacy, knowledge of Medicare/Medicaid, and experience with medical

Qualifikationen

• 1–3 years of Home Health or Infusion Pharmacy experience required.
• Knowledge of Medicare/Medicaid & commercial insurance required.
• Experience with medical authorizations required.
• Excellent customer service and communication skills.

Aufgaben

• Review inbound referrals and correspondence for processing, fulfilment or resolution.
• Screen physician orders and documentation for required information.
• Verify benefits coverage and eligibility for services.
• Provide referral management education to members and providers.
• Coordinate timely delivery of care and services with providers.

Kenntnisse

Home Health experience

Infusion Pharmacy experience

Medicare/Medicaid knowledge

Medical authorizations

Billing knowledge

Customer service

Communication skills

Microsoft Word

Microsoft Outlook

Microsoft Excel

Tools

Microsoft Word

Microsoft Outlook

Microsoft Excel

Jobbeschreibung

Become a part of our caring community The Care Management Support Assistant contributes to administration of care management. Provides non-clinical support to the assessment and evaluation of members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. The Care Management Support Assistant performs basic administrative/clerical/operational/customer support/computational tasks. Typically works on routine and patterned assignments.

The Care Management Support Assistant will review inbound referrals and correspondence for processing, fulfilment or resolution utilizing all appropriate software systems and resources. Screen physician's orders and documentation to identify that all qualifying medical documentation and required information is included. When necessary, request additional applicable information from referring entity. Perform verification of benefits coverage and eligibility for services per Health Plan contract. Review referral data matching it against specified medical terms and diagnoses or procedure codes and follow established procedures for approving request or referring request for further review. Provide referral management education to members and providers regarding medical benefits, referral status and prior authorizations. Communicate with patient to confirm demographics and explain the details of the services/care requested. Coordinate the timely delivery of care and services with providers. Also communicate with referring entities, providers, and members regarding final referral determination while maintaining detailed documentation to record patient, physician, referral source and provider interactions and communications. Work with Pre-Authorization, Utilization Management, Billing, Pharmacy, and Home Care regarding referred services. Maintain working knowledge of applicable CPT, HCPC, ICD-10 codes, and all insurance contracts. Understand Medicare/Medicaid criteria and Health Plan policies to ensure the referral meets all requirements and guidelines. Maintain knowledgeable of, and adhere to applicable federal/state regulations, laws related to patient confidentiality, release of information, and HIPAA. Always preserve the security and confidentiality of patients' personal information. Report ongoing issues with referring entities or providers that delay service delivery to manager. Provides excellent internal and external customer service by ensuring work meets quality standard.

Use your skills to make an impact

Required Qualifications

• 1-3 years of Home Health, or Infusion Pharmacy experience is required.
• Wound care/Ostomy supplies experience is preferred.
• Microsoft Office technical experience with Word, Outlook, and Excel is preferred.
• Knowledge of Medicare/Medicaid & commercial insurance is required.
• Experienced with medical authorizations is required.
• Knowledge of medical billing is preferred.
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
• Excellent customer service and communication skills.

Additional Information

• Weekends: 8:00 AM-5:00 PM, with holiday coverage; flexibility to pick up approximately 1 additional hour per week to meet the 20-hour weekly requirement.
• Remote (Subject to potential future adjustments based on evolving business requirements)
• Overtime: As needed

Florida Background Screening Requirements:

Notice for candidates applying to this position from a Florida work location, including Florida home-based work location. This position is subject to Florida Level 2 background screening through the Care Provider Background Screening Clearinghouse. For information about the screening process and requirements, visit: https://info.flclearinghouse.com.

Scheduled Weekly Hours

20

Pay Range

$38,000 - $45,800 per year

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About Us

About OneHome: OneHome coordinates a full range of post-acute care ranging from home heal