Become a part of our caring community
 

As a Referral and Scheduling Coordinator, you will be responsible for obtaining authorizations for medications, injections & contraceptive devices, scheduling appointments, taking payments, and calculating out of pocket costs based on insurance coverage, in addition the Referral and Scheduling Coordinator serves as liaison between the organization and Specialty Pharmacies, to assist with coordinating specialty pharmacy medications. These services provide a smooth process for our patients by using “buy and bill” and/or specialty pharmacy.

Role Responsibilities:

• Contact insurance carriers to verify patient’s insurance eligibility, benefits, and requirements.
• Basic Knowledge of procedure codes (CPT) and diagnoses codes (ICD-10) to receive authorizations.
• Communicate with insurance companies, specialty pharmacies, vendors, and internal customers, to maximize efficiencies, and streamline process.
• Work with department leadership to develop policies, and workflows to support the auth ordering process.
• Request, track and obtain authorization from insurance carriers within time allotted for medial treatment. This includes processing denials and appeals.
• Review details and expectations about the authorization process with patients.
• Demonstrate and apply knowledge of medical terminology.
• Demonstrate high proficiency of general medical office procedures, including HIPAA regulations.
• Be the main point of contact for patients with regards to authorizations.
• Review clinical documentation to ensure it supports the insurance requirements for approval.
• Ensure that authorizations are addressed in a timely manner and the clinical teams are notified of delays, and when complete.
• Clearly document all communications and contacts with providers and personnel utilizing standardized documentation requirements, including proper format.
• Work with Purchasing department and care center leaders to assist with inventory management of purchased meds and consignment medication.
• Other duties as assigned.

Use your skills to make an impact
 

Required Qualifications:

• Previous experience in authorization and knowledge of medical terminology
• Proficiency in Microsoft Office

• Excellent professional communication abilities, at all levels within the organization and with patients, at all times

Preferred Qualifications

• 1+ year of Insurance Verification and Authorization Retrieval
• Proficiency with Electronic Medical Records
• Bilingual in English and Spanish with the ability to read/write/speak fluently in both languages

Knowledge, skills and abilities:

• Knowledge of health care field and medical office protocols/procedures.
• Knowledge of billing practices and clinic policies and procedures.
• Knowledge of coding and clinic operating policies.
• Must be able to communicate clearly, accurately, and professionally with patients, internal and external customers, including insurance representatives. 
• Must be able to consistently demonstrate a high level of organization. 
• Must consistently demonstrate strong attention to details. 

Additional Information:

This role is considered patient facing and is part of the company's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB

 

 

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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About Us
 

About CenterWell Senior Primary Care: CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes. We go beyond physical health by also addressing other factors that can impact a patient’s well-being.

About CenterWell, a Humana company: CenterWell is a leading healthcare services business focused on creating integrated and differentiated experiences that put our patients at the center of everything we do. The result is high-quality healthcare that is accessible, comprehensive and, most of all, personalized. As the largest provider of senior-focused primary care, a leading provider of home healthcare and a leading integrated home delivery, specialty, hospice and retail pharmacy, CenterWell is focused on whole health and addressing the physical, emotional and social wellness of our patients. CenterWell is part of Humana Inc. (NYSE: HUM). Learn more about what we offer at CenterWell.com.

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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.