Referrals Coordinator

Profile

Description

The Referrals Coordinator 2 processes referrals from Civilian providers. The Referrals Coordinator 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Typically works on semi-routine assignments.

Responsibilities

The Referrals Coordinator 2 includes data entry into 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


Recognizes a sensitive diagnosis and/or referral requiring Case Management and pend 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 code to referral as well as appropriate CPT Code.
Decisions are typically focus on interpretation of area/department policy and methods for completing assignments.
Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction.
Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.


Our Department of Defense Contract requires U.S. citizenship for this position .

Required Qualifications


Our Department of Defense Contract requires U.S. citizenship for this position
Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing)
2 plus years of customer service experience
2 plus years of administrative/data entry experience
2 plus years of healthcare experience with Intermediate working knowledge using medical terminology, CPT and ICD codes
Must be able to work autonomously and be self-driven
Must be able to meet productivity metrics
Expertise with MS Office products (Outlook, Word, PowerPoint, Excel) and ability to easily navigate multiple computer applications
Above average written and verbal skills including organizational abilities
Strong attention to detail
The ability and willingness to work an 8-hour shift sometime between the hours of 8 a.m. to 5 p.m. Monday through Friday and some potential overtime (Based on business need)


Work at Home/Remote Requirements


To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
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
Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information


Preferred Qualifications


Veterans or Military Spouses
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
Flexibility with schedule


Additional Information

Work Days/Hours :


Monday - Friday; must be able to work an 8-hour shift between 8:00 a.m. - 5 p.m.
Ability to work overtime depending on business needs


Training :

Performed virtually, with length of training depending on progression of trainee - 1-2 months

Benefits Start Upon Date of Hire:


Medical, Dental, Vision
Will be eligible for P4P (Pay for Performance): New hires must successfully complete the 90 day or extended probationary period to qualify for the next cycle
401K/Roth 6% match at 125% & fully vested after 2 years
23 days accrued PTO
7 major recognized holidays
1 volunteer day
Education reimbursement


Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ****

Company info

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