Managed Care Referrals & Benefits Specialist

Aperion Care; Niles Township (IL); On-site; USD 45,000 - 65,000; Full time

Job summary

Aperion Care is seeking a referral coordination professional to triage daily referral requests for Commercial, MMAI, and Medicare Advantage plans for skilled care stays across facilities.

The role includes verifying plan benefits and coordinating with case managers, facilities, and marketing to ensure complete information is provided. A college degree and MCO experience are preferred.

Qualifications

• College degree is preferred.
• Experience working in a skilled nursing facility.
• Understanding of how claims are paid under Commercial and Medicare Advantage plans for skilled services.
• 2 years working with MCO insurance experience is preferred.

Responsibilities

• Triages daily referral requests for all plans for skilled care stays.
• Acts as liaison between marketing, admissions and MCO Case Management.
• Reviews referral requests for completeness before handing to a case manager.
• Performs benefit verifications on referrals per processes.
• Ensures facilities adhere to referral processes for MCO cases.
• Maintains the Manage Care Referral Log.
• Assists Case Management Consultant with authorizations and insurance communications.

Skills

MCO insurance experience

Strong organizational skills

Problem-solving

Multitasking

Education

College degree (preferred)

Job description

Aperion Care is seeking a referral coordination professional to triage daily referral requests for Commercial, MMAI, and Medicare Advantage plans for skilled care stays across facilities.

The role includes verifying plan benefits and coordinating with case managers, facilities, and marketing to ensure complete information is provided. A college degree and MCO experience are preferred.