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Pre-Service Coordinator

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Humana

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Location:
United States , Miramar, Florida

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Category:
-

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Contract Type:
Not provided

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Salary:

39000.00 - 49400.00 USD / Year
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Job Description:

Become a part of our caring community and help us put health first. The Pre-Service Coordinator is responsible for all aspects of referral management and accurately process incoming requests for homecare, DME/supplies and pharmacy/infusion services meeting the timeline expectations as outlined in the Health Plan contractual agreements.

Job Responsibility:

  • Responsible for all aspects of referral management and accurately process incoming requests for homecare, DME/supplies and pharmacy/infusion services meeting the timeline expectations as outlined in the Health Plan contractual agreements
  • Review 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
  • Coordinate the timely delivery of care and services with providers
  • Communicate with referring entities, providers, and members regarding final referral determination while maintaining detailed documentation to record patient, physician, referral source and provider interactions and communications
  • Work with Pre-Authorization, Utilization Management, Billing, Pharmacy, Home Care and DME regarding referred services
  • Maintain working knowledge of applicable CPT, HCPC, ICD-10 codes, and all insurance contracts
  • Understand Medicare/Medicaid criteria and Health Plan policies to ensure the referral meets all requirements and guidelines
  • Maintain knowledgeable of, and adhere to applicable federal/state regulations, laws related to patient confidentiality, release of information, and HIPAA
  • Always preserve the security and confidentiality of patients’ personal information
  • 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 standard

Requirements:

  • 1-3 years of Home Health, DME (Durable Medical Equipment), or Infusion Pharmacy experience is required
  • Knowledge of Medicare/Medicaid & commercial insurance is required
  • Experienced with medical authorizations is required
  • Must be passionate about contributing to an organization focused on continuously improving consumer experiences
  • Excellent customer service and communication skills

Nice to have:

  • Wound care/Ostomy supplies experience is preferred
  • Microsoft Office technical experience with Word, Outlook, and Excel is preferred
  • Knowledge of medical billing is preferred
What we offer:
  • Medical, dental and vision benefits
  • 401(k) retirement savings plan
  • Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
  • Short-term and long-term disability
  • Life insurance

Additional Information:

Job Posted:
January 15, 2026

Employment Type:
Fulltime
Work Type:
Remote work
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