Referrals Coordinator

Humana

15h • $39,000 - $49,400 • Remote

About The Position

Become a part of our caring community and help us put health first The Referrals Coordinator 2 process referrals from Military Treatment Facilities (MTFs) and civilian providers. As a Referrals Coordinator 2, you will handle some inbound calls, perform data entry into the medical management system, assigning an appropriate provider, reviewing for benefits, and/or medical necessity as required or pending to a nurse or supervisor who can complete or request additional information. Role Responsibilities You will recognize a sensitive diagnosis and/or referral requiring Case Management and pend to appropriate point of contact for review. You will understand TRICARE benefits/limitations and Humana Military referral processes, MOUs with MTFs, and referral and UM policies. You will answer questions or contacts MTFs and/or civilian providers to obtain additional information that may be required to complete referral etc. You will assign appropriate ICD10 code to referral as well as appropriate CPT Code. Use your skills to make an impact

Requirements

• Our Department of Defense Contract requires U.S. citizenship for this position
• Successfully receive interim approval for government security clearance (NBIS - National Background Investigation Services)
• HGB is not authorized to do work in Puerto Rico per our government contract. We are not able to hire candidates that are currently living in Puerto Rico.
• 2 years of customer service experience AND/OR administrative/data entry experience
• 2 years of healthcare experience with Intermediate working knowledge using medical terminology, CPT and ICD codes
• Expertise with MS Office products (Outlook, Word, PowerPoint, Excel) and ability to easily navigate multiple computer applications
• The ability and willingness to work an 8-hour shift between the hours of 8 a.m. to 5 p.m. Eastern Standard Time (EST) and some potential overtime (Based on business need)
• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
• Satellite, cellular and microwave connection can be used only if approved by leadership

Nice To Haves

• Veteran or Military Spouse
• Individuals with an understanding of TRICARE benefits/limitations, Humana Military referral processes, MOUs with MTFs, and referral and UM policies.
• College degree
• Experience in a Managed Care setting
• Advanced experience with medical terminology and ICD10 codes

Responsibilities

• process referrals from Military Treatment Facilities (MTFs) and civilian providers
• handle some inbound calls
• perform data entry into the medical management system
• assigning an appropriate provider
• reviewing for benefits, and/or medical necessity as required or pending to a nurse or supervisor who can complete or request additional information
• recognize a sensitive diagnosis and/or referral requiring Case Management and pend to appropriate point of contact for review
• understand TRICARE benefits/limitations and Humana Military referral processes, MOUs with MTFs, and referral and UM policies
• answer questions or contacts MTFs and/or civilian providers to obtain additional information that may be required to complete referral etc
• assign appropriate ICD10 code to referral as well as appropriate CPT Code

Benefits

• Humana provides 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 and many other opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed