Humana

EReferral Specialist Home Health Per Diem

San Antonio, Texas, United States

Not SpecifiedCompensation
Entry Level & New Grad, Junior (1 to 2 years)Experience Level
Part TimeJob Type
UnknownVisa
Healthcare, Home Health CareIndustries

Requirements

Candidates must possess a High School Diploma or equivalent, with an Associate's degree preferred. A minimum of 1 year of customer service or healthcare-related experience is required, preferably in a home health environment. Experience with healthcare insurance verification and a working knowledge of Medicare enrollment and home health agency guidelines are preferred. The ability to type 40 WPM, comprehend basic math for data analysis, and demonstrate strong logical thinking, decision-making, customer service, and communication skills are essential. Candidates must also possess strong attention to detail, time management skills, adaptability, and the ability to work under pressure and adhere to strict timelines. Fluency in English (reading, writing, speaking) and good attendance are mandatory. Reliable internet service with at least 25 Mbps download and 10 Mbps upload speeds is also required.

Responsibilities

The E-Referral Specialist is responsible for monitoring multiple e-referral systems to identify new referrals, managing alerts, and continuously monitoring email for referral requests. This role involves performing timely follow-ups, managing related communication, and scanning documentation to determine patient eligibility for services. The specialist will assist with authorizations, monitor referral statuses, and report on them weekly. They will communicate with branch, sales, and leadership regarding status updates and referral decisions, and maintain the ERST log with all referral and ROC decisions. Maintaining productivity levels, complying with regulatory compliance areas, policies, and procedures, and adhering to company best practices are also key responsibilities. The role may also involve performing other related duties as assigned.

Skills

e-referral systems
referral management
healthcare insurance verification
customer service
home health
data collection
documentation
compliance
authorization submission
communication (email/phone)

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters
1961Year Founded
IPOCompany Stage
Social Impact, HealthcareIndustries
10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.
Rising medical costs and tightening Medicare reimbursements may strain financial performance.
Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.
The company emphasizes inclusivity, offering free language interpreter services for accessibility.
Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.
The company is the first insurer to cover TMS therapy for adolescent depression.
Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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