Care Management Support Assistant

🔥 12 hours ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $38k - $45.8k / year

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Review inbound referrals and correspondence for processing, fulfilment, or resolution • Screen physician orders and documentation for required medical information • Request additional information from referring entities when necessary • Verify benefits coverage and service eligibility under Health Plan contracts • Review referral data against medical terms, diagnoses, and procedure codes • Approve requests or refer them for further review according to established procedures • Educate members and providers about referral management, medical benefits, referral status, and prior authorizations • Confirm patient demographics and explain requested services and care • Coordinate timely delivery of care and services with providers • Communicate referral determinations to referring entities, providers, and members • Maintain detailed documentation of patient, physician, referral source, and provider interactions • Collaborate with Pre-Authorization, Utilization Management, Billing, Pharmacy, and Home Care • Maintain knowledge of CPT, HCPC, and ICD-10 codes, insurance contracts, Medicare/Medicaid criteria, and Health Plan policies • Adhere to federal and state regulations concerning patient confidentiality, release of information, and HIPAA • Protect patients’ personal information • Report service-delivery delays to the manager • Ensure work meets quality standards and provide excellent internal and external customer service

🎯 Requirements

• 1-3 years of Home Health or Infusion Pharmacy experience required • Knowledge of Medicare/Medicaid and commercial insurance required • Experience with medical authorizations required • Wound care/Ostomy supplies experience preferred • Microsoft Office technical experience with Word, Outlook, and Excel preferred • Knowledge of medical billing preferred • Excellent customer service and communication skills • Passion for contributing to continuous improvement of consumer experiences • Minimum home internet speed of 25 Mbps download and 10 Mbps upload • Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information • Subject to Florida Level 2 background screening through the Care Provider Background Screening Clearinghouse

🏖️ Benefits

• Medical, dental and vision benefits • 401(k) retirement savings plan • Paid time off • Company and personal holidays • Paid parental and caregiver leave • Short-term and long-term disability • Life insurance • Comprehensive benefits package supporting health and financial well-being • Remote work arrangement • Occasional travel to Humana offices for training or meetings