Referrals Coordinator

Humana • HGB SCA Remote GA, GA

20h • $39,000 - $49,400 • Remote

About The Position

As a Referrals Coordinator, you will perform data entry into medical management system, assigning an appropriate provider, reviewing for benefits, and as required pending to a nurse or supervisor who can complete the medical necessity review or request additional information. Recognizes a sensitive diagnoses and/or referral requiring Case Management, and send to appropriate point of contact for review. Understands TRICARE benefits/limitations and Humana Military referral processes, MOUs with MTFs, and referral and UM policies. Answers questions or contacts MTFs and/or civilian providers to obtain additional information that may be required to complete referral etc. Requires assigning appropriate ICD10 codes to referral as well as appropriate CPT Codes. Decisions are limited to defined parameters around work expectations, quality standards, priorities, and timing. Works under close clinical supervision and/or within established policies/practices and guidelines with minimal opportunity for deviation. Under direct clinical supervision, the Referrals Coordinator 2 process referrals from Military Treatment Facilities (MTFs) and civilian providers. The Referrals Coordinator performs basic administrative/clerical/operational/customer support/computational tasks. Typically works on routine and patterned assignments. Activities do not require evaluation or interpretation of clinical information.

Requirements

• High school diploma or equivalent
• UM/Coding experience and/or medical terminology
• U.S. citizenship for this position
• Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing)

Nice To Haves

• 2 years prior Humana Government Business experience
• 3 years of experience in public contact position
• Associate or Bachelor’s Degree
• Military health care service experience or working knowledge of TRICARE entitlement program.

Responsibilities

• Processes referrals/authorizations in accordance with established cycle time and quality standards including during contingency operations.
• Enters information into MSR computer and other required/applicable systems.
• Performs timely and accurate data entry of changes to beneficiary contact information in accordance with established department procedures.
• Prepares and submits reports of findings in accordance with requirements defined by the supervisor and maintains complete and accurate files related to assigned activities.
• Becomes proficient in a variety of skills that enables the associate to respond to unexpected operational needs.
• Accomplishes other projects and duties as assigned.
• Participates in process and performance improvement activities.

Benefits

• medical
• dental
• vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED