Description

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

The E-Referral Specialist is an integral part of the referral process as this role is the initial contact point for the client or referral source to promote the continuity of care.  The role is responsible for data collection and documentation, compliance, and consistent follow up on the initial referral process and decision.

Essential Functions: 

• Monitor multiple e-referral systems to identify new referrals and manage alerts and notifications.
• Monitor email continuously for request to pull referrals from all applicable referral systems. Perform timely follow-up and manage all related communication.
• Quickly scan documentation to determine patient eligibility for services (service area, orders, insurance, etc.)
• Assists, as needed, with authorizations to ensure all are submitted in a timely manner.
• Monitors status of all referrals received, follow up with each throughout process, reports on status weekly.
• Communicate with branch, sales, leadership via email and/or phone for status updates and referral decisions as required.
• Daily manage and update ERST log with all referrals and ROCs decisions.
• Maintain acceptable productivity level, as determined by work assignment and departmental standards.
• Comply with and adhere to all regulatory compliance areas, policies and procedures and company best practices.
• Performs other related duties as assigned.

Use your skills to make an impact
 

Required Experience/Skills:

• High School Diploma or its equivalent; Associates degree preferred
• Healthcare insurance verification experience preferred
• Minimum 1 year customer service or other healthcare related experience; preference working in a home health environment
• Good knowledge of the issues related to the delivery of home health services preferred
• Working knowledge of Medicare enrollment and guidelines governing home health agencies preferred
• Demonstrate ability to type 40 wpm
• Ability to comprehend and apply principles of basic math while analyzing data and generating reports
• Good logical thinking and decision making skills
• Able to work well under pressure and adhere to strict timelines
• Possess excellent customer service skills; ability to communicate professionally and effectively with all levels of management
• Strong attention to detail with ability to multi-task and work with multiple screens/systems.
• Good time management skills and are able to work in a fast-paced environment
• Strong adaptability to change
• Must read, write and speak fluent English
• Must have good and regular attendance
• Approximate percent of time required to travel: 0%

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Home or Hybrid Home/Office employees will be provided with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

CenterWell Home Health offers a variety of benefits to promote the best health and well-being of our employees and their families. Our competitive and flexible benefits surround you with support the same way you do for our patients and members, including:

• Health benefits effective day 1
• Paid time off, holidays, and jury duty pay
• Recognition pay
• 401(k) retirement savings plan with employer match
• Tuition assistance
• Scholarships for eligible dependents
• Caregiver leave
• Employee charity matching program
• Network Resource Groups (NRGs)
• Career development opportunities

Travel: While this is a remote position, occasional travel to Humana’s offices for training or meetings may be required.

Scheduled Weekly Hours

1

Pay RangeThe 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 BenefitsHumana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers benefits for limited term, variable schedule and per diem associates which are designed to support whole-person well-being. Among these benefits, Humana provides paid time off, 401(k) retirement savings plan, employee assistance program, business travel and accident.