Care Management Support Assistant

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

📋 Description

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

• Assess physician orders and documentation for necessary medical information.

• Obtain additional information from referring entities as needed.

• Confirm benefits coverage and service eligibility under Health Plan contracts.

• Analyze referral data in relation to medical terms, diagnoses, and procedure codes.

• Authorize requests or escalate them for further evaluation following established procedures.

• Provide education to members and providers regarding referral management, medical benefits, referral status, and prior authorizations.

• Validate patient demographics and clarify requested services and care.

• Ensure timely coordination of care and services with providers.

• Relay referral decisions to referring entities, providers, and members.

• Keep thorough documentation of interactions with patients, physicians, referral sources, and providers.

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

• Stay updated on CPT, HCPC, and ICD-10 codes, insurance contracts, Medicare/Medicaid criteria, and Health Plan policies.

• Comply with federal and state regulations related to patient confidentiality, information release, and HIPAA.

• Safeguard patients’ personal information.

• Notify the manager of service delivery delays.

• Ensure work meets quality standards while delivering exceptional internal and external customer service.

⛳️ Requirements

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

• Familiarity with Medicare/Medicaid and commercial insurance is essential.

• Experience with medical authorizations is mandatory.

• Experience with wound care/Ostomy supplies is preferred.

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

• Understanding of medical billing is preferred.

• Exceptional customer service and communication skills are required.

• A strong commitment to enhancing consumer experiences is essential.

• Minimum home internet speed of 25 Mbps for download and 10 Mbps for upload is required.

• A dedicated workspace free from interruptions to protect member PHI/HIPAA information is necessary.

• 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 coverage.

• Life insurance.

• Comprehensive benefits package supporting health and financial well-being.

• Remote work arrangement.

• Occasional travel to Humana offices for training or meetings.