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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in referral management, medical authorizations, and insurance verification while ensuring compliance with HIPAA regulations. Strong communication and customer service skills are essential for coordinating care and educating members and providers.
Highest-signal resume keywords
Referral ManagementMedical AuthorizationsMedicare/Medicaid KnowledgeCPT, HCPC, ICD-10 Codes KnowledgeCustomer Service Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Medical DocumentationInsurance VerificationWound Care ExperienceHome Health ExperienceInfusion Pharmacy Experience
Soft Skills
Excellent Communication SkillsCustomer Service Orientation
Tools & Technologies
Microsoft OfficeWordOutlookExcel
Certifications & Qualifications
Florida Level 2 Background Screening
Industry Keywords
Health Plan ContractsPatient Information SecurityQuality StandardsHIPAA ComplianceMedical Billing
About the role
Key responsibilities & impact- Review inbound referrals and correspondence for processing, fulfilment, or resolution
- Screen physician orders and documentation for required medical information
- Request additional information from referring entities when necessary
- Verify benefits coverage and eligibility under Health Plan contracts
- Match referral data against medical terms, diagnoses, and procedure codes
- Follow procedures for approving requests or referring them for further review
- Provide referral management education to members and providers
- Communicate with patients to confirm demographics and explain requested services and care
- Coordinate timely delivery of care and services with providers
- Communicate referral determinations to referring entities, providers, and members
- Maintain detailed documentation of patient, physician, referral source, and provider interactions
- Collaborate with Pre-Authorization, Utilization Management, Billing, Pharmacy, and Home Care
- Maintain patient information security and confidentiality
- Report issues delaying service delivery to the manager
- Provide excellent internal and external customer service while meeting quality standards
- Work 11:00 am–7:30 pm with rotational weekends; overtime as needed
Requirements
What you’ll need- 1-3 years of Home Health or Infusion Pharmacy experience
- Knowledge of Medicare/Medicaid and commercial insurance
- Experience with medical authorizations
- Excellent customer service and communication skills
- Wound care/Ostomy supplies experience preferred
- Microsoft Office experience with Word, Outlook, and Excel preferred
- Knowledge of medical billing preferred
- Passion for contributing to an organization focused on continuously improving consumer experiences
- Must complete Florida Level 2 background screening through the Care Provider Background Screening Clearinghouse
- Must adhere to applicable federal/state regulations and HIPAA requirements
- Knowledge of applicable CPT, HCPC, and ICD-10 codes and insurance contracts
Benefits
Comp & perks- 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
- Comprehensive benefits package supporting employees’ and families’ health and financial well-being