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 answering the referral source, 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.
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%
Scheduled Weekly Hours
29Pay 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.
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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.About us
About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers – all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives.About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first – for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
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 veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.