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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, with a strong focus on customer service and compliance with HIPAA regulations. Proficient in coordinating care delivery and maintaining accurate documentation while educating members and providers on medical benefits.
Highest-signal resume keywords
Referral ManagementMedical AuthorizationsMedicare/Medicaid KnowledgeCPT/HCPC/ICD-10 CodesCustomer Service
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 ExperienceMedical BillingReferral Data Review
Soft Skills
Communication SkillsCustomer Service SkillsCollaboration
Tools & Technologies
Microsoft OfficeWordOutlookExcel
Certifications & Qualifications
Florida Level 2 Background Screening
Industry Keywords
Home HealthInfusion PharmacyHealth Plan PoliciesPatient ConfidentialityPrior Authorizations
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 service eligibility under Health Plan contracts
- Review referral data against medical terms, diagnoses, and procedure codes
- Approve requests or refer them for further review according to established procedures
- Educate members and providers about referral management, medical benefits, referral status, and prior authorizations
- Confirm patient 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 knowledge of CPT, HCPC, and ICD-10 codes, insurance contracts, Medicare/Medicaid criteria, and Health Plan policies
- Adhere to federal and state regulations concerning patient confidentiality, release of information, and HIPAA
- Protect patients’ personal information
- Report service-delivery delays to the manager
- Ensure work meets quality standards and provide excellent internal and external customer service
Requirements
What you’ll need- 1-3 years of Home Health or Infusion Pharmacy experience required
- Knowledge of Medicare/Medicaid and commercial insurance required
- Experience with medical authorizations required
- Wound care/Ostomy supplies experience preferred
- Microsoft Office technical experience with Word, Outlook, and Excel preferred
- Knowledge of medical billing preferred
- Excellent customer service and communication skills
- Passion for contributing to continuous improvement of consumer experiences
- Minimum home internet speed of 25 Mbps download and 10 Mbps upload
- Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information
- Subject to Florida Level 2 background screening through the Care Provider Background Screening Clearinghouse
Benefits
Comp & perks- 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
- Life insurance
- Comprehensive benefits package supporting health and financial well-being
- Remote work arrangement
- Occasional travel to Humana offices for training or meetings