Care Management Support Assistant

This is a fully remote position, open to applicants in Florida.

📋 Description

• Evaluate incoming referrals and related correspondence for processing, fulfillment, or resolution.

• Assess physician orders and documentation to ensure necessary medical information is included.

• Solicit additional information from referring entities when required.

• Confirm benefits coverage and eligibility in accordance with Health Plan contracts.

• Align referral data with medical terms, diagnoses, and procedure codes.

• Adhere to procedures for approving requests or escalating them for further review.

• Deliver referral management education to both members and providers.

• Interact with patients to verify demographics and clarify requested services and care.

• Ensure timely coordination of care and services with providers.

• Notify referring entities, providers, and members of referral decisions.

• Keep detailed records of interactions involving patients, physicians, referral sources, and providers.

• Collaborate with Pre-Authorization, Utilization Management, Billing, Pharmacy, and Home Care teams.

• Uphold the security and confidentiality of patient information.

• Report any issues that hinder service delivery to the manager.

• Provide exceptional internal and external customer service while adhering to quality standards.

• Work from 11:00 am to 7:30 pm with rotating weekends; overtime as required.

⛳️ Requirements

• 1-3 years of experience in Home Health or Infusion Pharmacy.

• Familiarity with Medicare/Medicaid and commercial insurance.

• Experience in medical authorizations.

• Strong customer service and communication abilities.

• Preferred experience with wound care and ostomy supplies.

• Proficiency in Microsoft Office, particularly Word, Outlook, and Excel, is preferred.

• Knowledge of medical billing is advantageous.

• A passion for enhancing consumer experiences within an organization.

• Completion of Florida Level 2 background screening through the Care Provider Background Screening Clearinghouse is required.

• Compliance with applicable federal/state regulations and HIPAA requirements is essential.

• Understanding of relevant CPT, HCPC, and ICD-10 codes, as well as insurance contracts.

🏝️ Benefits

• Medical benefits.

• Dental benefits.

• Vision benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays.

• Personal holidays.

• Paid parental leave.

• Paid caregiver leave.

• Short-term disability.

• Long-term disability.

• Life insurance.

• A comprehensive benefits package that supports the health and financial well-being of employees and their families.