Pre-Service Coordinator Job at Humana (Miramar, Florida)

Pre-Service Coordinator

Humana

Location:
United States , Miramar, Florida

Category:
-

Contract Type:
Not provided

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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Job Link Share:

Pre-Service Coordinator

Humana

Location:
United States , Miramar, Florida

Category:
-

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:
January 15, 2026

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Pre-Service Coordinator

Humana

Location:United States , Miramar, Florida

Category:-

Contract Type:Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:January 15, 2026

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