Anthem, Inc. Referral Services Assistant (myNEXUS) in Walnut Creek, California
SHIFT: Day Job
Your Talent. Our Vision. At myNEXUS, a proud member of the Anthem, Inc. family of companies, it’s a powerful combination. It’s the foundation upon which we’re creating greater access to care for our members, greater value for our customers and greater health for our communities. Join us and together we will drive the future of health care.
myNEXUS is a technology-driven, care and benefit management service that enables individuals to live healthier lives in their homes. Our proven clinical model connects individuals to intelligent care delivering independence at lower costs. To maximize health delivery, we consistently leverage our: Innovative Technologies, Advanced Clinical Expertise, and Proprietary Network Engagement Platform. We are continuously pioneering ways to optimize health resources for our clients and their customers. Through our proprietary network management and engagement programs, we realize enhancements in quality, outcomes, and care effectiveness.
Responsible for providing support to clinical team to facilitate the administrative components of clinical referrals for case management or disease management services to include home health, nutritional counseling, etc.
Primary duties may include, but are not limited to:
Initiates and manages clinical referrals for participants registered in a disease management or health program.
Acts as a liaison between hospital, health plans, physicians, patients, vendors and other referral sources
. Reviews referrals for completeness and follows up for additional information.
Assigns referrals to staff.
Verifies insurance coverage and obtains authorizations from insurance plans.
Maintains database of insurance companies for verification of coverage, accepted plans, and requirements for patient eligibility.
Contacts physician offices to obtain demographic information or related data.
Enters referrals and documents communications in system.
Requires a high school diploma;
1 year of experience in a healthcare environment; or any combination of education and experience, which would provide an equivalent background. Ability to travel may be required.
Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.
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