Job description

The Pre-Service Coordinator position is responsible for all aspects of referral management. The Pre-Service Coordinator will accurately process incoming requests for homecare, DME/supplies and pharmacy/infusion services meeting the timeline expectations as outlined in the Health Plan contractual agreements.

What to expect in your role:

• Review of inbound referrals and correspondence for processing, fulfilment or resolution utilizing all appropriate software systems and resources
• Screen physician’s orders and documentation to identify that all qualifying medical documentation and required information is included. When necessary, request additional applicable information from referring entity
• Perform verification of benefits coverage and eligibility for services per Health Plan contract
• Review referral data matching it against specified medical terms and diagnoses or procedure codes and follow established procedures for approving request or referring request for further review
• Provide referral management education to members and providers regarding medical benefits, referral status and prior authorizations
• Communicate with patient to confirm demographics and explain the details of the services/care requested
• Communicate with referring entities, providers, and members regarding final referral determination
• Work with Pre-Authorization, Utilization Management, Billing, Pharmacy, Home Care and DME regarding referred services
• Coordinate the timely delivery of care and services with providers
• Manage communication and correspondence with referring entities, insurance companies, providers and internal customers as required
• Maintain detailed documentation to record patient, physician, referral source and provider interactions and communications.
• Maintain working knowledge of applicable CPT, HCPC, and ICD-10 codes
• Maintain working knowledge of all insurance contracts
• Understand Medicare/Medicaid criteria and Health Plan policies to ensure the referral meets all requirements and guidelines
• Preserve the security and confidentiality of patients’ personal information at all times
• Maintain a working knowledge of, and adhere to applicable federal/state regulations including but not limited to, laws related to patient confidentiality, release of information, and HIPAA
• Report ongoing issues with referring entities or providers that delay service delivery to manager
• Provides excellent internal and external customer service by ensuring work meets quality standards

What you need to succeed:

• Proficiency in English (verbal and written)
• Bilingual preferred
• Excellent communication skills
• Employ strong prioritization skills and a sense of urgency
• Ability to make decisions that adhere to policy or operational guideline using basic critical thinking skills
• Possesses the ability to handle multiple tasks at the same time
• Dependable with customer service mindset
• High School graduate or equivalent
• Knowledge of medical terminology
• Knowledge of Medicare/Medicaid & commercial/private insurance benefits, medical authorizations/billing preferred
• 1-3 years Healthcare, DME, medical industry experience

What we offer to you:

“We care for our employees as much as we care for our patients, which is why we offer a comprehensive benefits package, generous PTO, and employee wellness programs.”

Equal Opportunity Employer
It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster.

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee discount
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday
• Weekend availability

Education:

• High school or equivalent (Required)

Experience:

• Medical terminology: 3 years (Required)
• Computer skills: 3 years (Required)
• Verification of Eligibility: 3 years (Required)
• Home health: 1 year (Required)
• DME: 1 year (Required)
• Prior Authorization: 2 years (Required)

Work Location: Remote

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