You must reside in one of the following states for this position:
AL, AR, AZ, GA, IA, ID, IL, IN, KS, KY, LA, MI, MO, MS, NY, OH, OK, PA, SC, TN, TX, UT, WI

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations. This division currently operates in Tennessee, Georgia, Missouri, Kansas, Oklahoma, Utah, Texas, Mississippi, Iowa, Idaho, Louisiana, and Indiana with planned expansion into other states in 2025. For more information, visit AmHealthPlans.com .

If you would like to be part of a collaborative, supportive and caring team, we look forward to receiving your application!

Benefits and Perks include:

• Affordable Medical/Dental/Vision insurance options
• Generous paid time-off program and paid holidays for full time staff
• TeleDoc 24/7/365 access to doctors
• Optional short- and long-term disability plans
• Employee Assistance Plan (EAP)
• 401K retirement accounts with company match
• Employee Referral Bonus Program

POSITION SUMMARY:

The purpose of this position is to assume primary responsibility for receiving, screening and processing all referral and intake information.

ESSENTIAL JOB DUTIES:

To perform this job, an individual must perform each essential function satisfactorily, with or without a reasonable accommodation; including, but not limited to:

• Receives, screens and processes all referral information
• Performs verification of benefits:
  o Verify benefits
  o Verify payment method and amount
  o Obtain prior authorization to ensure that services are reimbursable prior to admission
  o Assign appropriate payer category to be keyed by facility personnel
  o Scan information back to requesting facility
• Ensure timely and accurate processing of all referrals/admissions
• Back-up for review of potential insurance contracts
• Adheres to ethical business practices by striving to perform in a manner that conforms to the highest standards of ethical behavior, integrity and honesty
• Takes initiative and responsibility for decisions as an individual and as a company. Exhibits commitment to personal and companywide goals
• Encourages a positive environment and experience for co-workers
• Treats employees with respect and embraces diversity and demonstrates the ability to work together.
• Promotes a safe and efficient working environment by adhering to agency policies and procedures
• Adheres to departmental and agency dress codes as observed by supervisor
• Performs other duties as assigned by supervisor'

Required Skills:

• Communication skills and active listening

Required Work Experience:

• Three (3) years experience is a healthcare related environment preferred

Licensing/Certification/Education Requirements:

• High School Diploma required

Other Requirements:

• Position may require unscheduled overtime, week-end work
• Must be willing and able to work flexible hours
• Travel required

Required Computer Software/Equipment Used:

• Microsoft Suite including Outlook, Excel, and Word
• Ability to learn HRIS and/or scheduling systems
• Standard Office Equipment
• Computer

EQUAL OPPORTUNITY EMPLOYER

Our Organization does not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. The Organization will also make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made.

This employer participates in E-Verify.