Referrals Coordinator

This is a fully remote position, open to applicants in United States.

📋 Description

• Input data into the medical management system.

• Allocate suitable providers to referrals.

• Evaluate referrals to determine eligibility for benefits.

• Place referrals on hold for a nurse or supervisor to assess medical necessity or gather further details.

• Identify sensitive diagnoses and referrals that need Case Management and direct them appropriately.

• Utilize knowledge of TRICARE benefits and limitations, Humana Military referral procedures, MOUs with MTFs, and referral and UM policies.

• Address inquiries and reach out to MTFs or civilian providers for additional information as needed.

• Assign appropriate ICD10 and CPT codes to the referrals.

• Manage referrals and authorizations in accordance with cycle-time and quality standards, including during contingency operations.

• Input data into MSR and other necessary systems.

• Accurately and promptly update beneficiary contact details.

• Compile and submit reports of findings.

• Keep complete and precise files.

• React to unforeseen operational demands.

• Fulfill assigned projects and responsibilities.

• Engage in activities aimed at process and performance enhancement.

• Handle referrals from Military Treatment Facilities and civilian providers under direct clinical supervision.

• Execute routine administrative, clerical, operational, customer support, and computational tasks.

⛳️ Requirements

• High school diploma or an equivalent qualification.

• Experience in UM/Coding and/or familiarity with medical terminology.

• U.S. citizenship is mandatory as per Department of Defense Contract.

• Must successfully obtain interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing).

• Minimum home internet speed of 25 Mbps for downloads and 10 Mbps for uploads is required.

• Work from a designated area free from ongoing interruptions to safeguard member PHI / HIPAA information.

• Preferred: 2 years of prior experience with Humana Government Business.

• Preferred: 3 years of experience in a position involving public contact.

• Preferred: Associate or Bachelor’s Degree.

• Preferred: Experience in military health care service or a working knowledge of the TRICARE entitlement program.

🏝️ Benefits

• Bonus incentive plan based on company and/or individual performance.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays.

• Personal holidays.

• Paid parental leave.

• Paid caregiver leave.

• Short-term disability.

• Long-term disability.

• Life insurance.

• Dedicated home workspace arrangement.

• Remote work arrangement.

• Occasional travel to Humana offices for training or meetings.