Pre-Service Coordinator

Job Description:

Pre-Service Coordinator

The Pre-Service Coordinator is responsible for all aspects of referral management and accurately process incoming requests for homecare, DME/supplies and pharmacy/infusion services meeting the timeline expectations as outlined in the Health Plan contractual agreements.
The Pre-Service Coordinator 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, Home Care and DME 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 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

• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

• Associate's degree or 2 years of healthcare/care coordinator experience

• Demonstrated excellent customer service and communication skills

• Microsoft Office proficiency

• Knowledge of medical authorizations/billing preferred

Additional Information

• Remote (Subject to potential future adjustments based on evolving business requirements)

• M-F (12:30p -9:00p ET)

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$39,000 - $49,400 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, volunteer time off, 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 health, infusion therapy and durable medical equipment services at patients’ homes. OneHome’s patient focused model creates one integrated point of accountability that coordinates with physicians, hospitals and health plans serving more than one million health plan members nationwide. OneHome was acquired by Humana in 2021 to advance value-based care. Our culture is inclusive, diverse, and above all, caring. It is important to us that our employees are engaged, supported and fairly treated. We offer a comprehensive benefits package to ensure the health and financial well-being of you and your family.

About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers, and our company. Through our Humana insurance services, and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer: It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.