Pre-Service Coordinator

Humana; Miramar (FL); Remote; USD 39,000 - 50,000; Full time

Job summary

A leading healthcare organization seeks a Pre-Service Coordinator to manage referral processes and enhance patient experiences. This role involves collaboration with multiple departments, ensuring compliance, and providing education about medical benefits. Join a diverse team dedicated to improving health outcomes for members.

Benefits

Medical Insurance

Dental Insurance

Vision Insurance

401(k)

Paid Time Off

Disability Insurance

Life Insurance

Qualifications

• 1-3 years experience in Healthcare, DME, or medical industry.
• Knowledge of Medicare/Medicaid & commercial insurance.

Responsibilities

• Responsible for referral management and processing requests.
• Educate members and providers about medical benefits and services.

Skills

Healthcare

Customer Service

Communication

Education

Associate's degree

Tools

Microsoft Office

Job description

Become a part of our caring community and help us put health first

The Pre-Service Coordinator is responsible for all aspects of referral management, accurately processing incoming requests for homecare, DME/supplies, and pharmacy/infusion services, ensuring they meet the timeline expectations outlined in the Health Plan contractual agreements.

The Pre-Service Coordinator reviews inbound referrals and correspondence for processing, fulfillment, or resolution using all appropriate software systems and resources. Responsibilities include screening physician’s orders and documentation to confirm all qualifying medical documentation and required information are included, requesting additional information when necessary, verifying benefits coverage and eligibility, and reviewing referral data against medical terms and codes. The role also involves providing education to members and providers about medical benefits, referral status, and prior authorizations, communicating with patients to confirm demographics and explain services, coordinating timely delivery of care, and maintaining detailed documentation of interactions. Collaboration with various departments such as Pre-Authorization, Utilization Management, Billing, Pharmacy, Home Care, and DME is essential, along with maintaining knowledge of relevant codes, insurance policies, and regulations to ensure compliance and confidentiality.

Use your skills to make an impact

Required Qualifications

• 1-3 years Healthcare, DME, or medical industry experience
• Less than 2 years of Microsoft Office technical experience with Word, Outlook, and Excel
• Knowledge of Medicare/Medicaid & commercial insurance
• Passion for contributing to an organization focused on improving consumer experiences

Preferred Qualifications

• Associate's degree or 2 years of healthcare/care coordinator experience
• Excellent customer service and communication skills
• Proficiency in Microsoft Office
• Knowledge of medical authorizations and billing preferred

Additional Information

• Remote position, subject to future adjustments based on business needs
• Work hours: M-F, 12:30 PM - 9:00 PM ET

Scheduled Weekly Hours: 40

Pay Range: $39,000 - $49,400 per year, based on location and experience

Description of Benefits: Humana offers comprehensive benefits including medical, dental, vision, 401(k), paid time off, disability, life insurance, and more to support your well-being.

About Us

About OneHome: We coordinate post-acute care services at patients’ homes, creating an integrated point of accountability with physicians, hospitals, and health plans serving over one million members nationwide. Acquired by Humana in 2021, our culture is inclusive, diverse, and caring.

About Humana: We are committed to putting health first, making it easier for people to achieve their best health through our insurance and healthcare services, improving quality of life for diverse populations.

Equal Opportunity Employer

Humana does not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or veteran status. We promote affirmative action and employment based on valid job requirements.

About the company

Humana considers every facet of your life to create personalized health paths.