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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, including verifying benefits coverage, processing physician orders, and ensuring compliance with Medicare/Medicaid regulations. Strong communication skills are essential for coordinating care and providing customer service to patients and providers.
Highest-signal resume keywords
Home Health ExperienceMedical AuthorizationsKnowledge Of Medicare/MedicaidCPT, HCPC, And ICD-10 CodesCustomer 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
Referral ManagementMedical DocumentationInsurance VerificationMedical BillingWound Care Experience
Soft Skills
Communication SkillsCustomer Service
Tools & Technologies
Microsoft OfficeWordOutlookExcel
Certifications & Qualifications
Florida Level 2 Background Screening
Industry Keywords
Patient ConfidentialityHIPAA ComplianceHealth Plan PoliciesInsurance ContractsHome Care Coordination
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 for services
- Review referral data against medical terms, diagnoses, and procedure codes
- Approve requests or refer them for further review according to established procedures
- 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 final referral determinations to referring entities, providers, and members
- Maintain detailed documentation of patient, physician, referral source, provider, and communication 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 internal and external customer service while meeting quality standards
Requirements
What you’ll need- 1-3 years of Home Health or Infusion Pharmacy experience required
- Wound care/Ostomy supplies experience preferred
- Microsoft Office technical experience with Word, Outlook, and Excel preferred
- Knowledge of Medicare/Medicaid and commercial insurance required
- Experience with medical authorizations required
- Knowledge of medical billing preferred
- Excellent customer service and communication skills
- Florida Level 2 background screening through the Care Provider Background Screening Clearinghouse
- Knowledge of applicable CPT, HCPC, and ICD-10 codes
- Knowledge of insurance contracts, Medicare/Medicaid criteria, and Health Plan policies
- Knowledge of applicable federal/state regulations, patient confidentiality, release of information, and HIPAA
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 health and financial well-being
- Flexible overtime as needed