Referral Coordinator 2 Humana Government Business

Profile

Description

The Referrals Coordinator 2 process referrals from Military Treatment Facilities (MTFs) and civilian providers. The Referrals Coordinator 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. 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 diagnoses 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

2 - 3 years Customer Service skills

2 - 3 years administrative/data entry experience

2 - 3 years healthcare experience

Must be able to work autonomously and be self-driven

Must meet be able to meet productivity metrics

Expertise with MS Office products and ability to easily navigate multiple computer applications

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing)

Work at Home requirements: Must ensure designated work area is free from distractions during work hours and virtual meetings. Must provide a high-speed DSL or cable modem for a workspace (Satellite and Hotspots are prohibited). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) for optimal performance of is required

Preferred Qualifications

College degree

Experience in a Managed Care setting

Experience with medical terminology and ICD10 codes

Flexibility with schedule

Additional information

Schedule: Monday-Friday from 8:00 am-5:00 pm CST. Overtime may be required and some weekends depending on workload

Training: Training will be done virtually, with length of training depending on progression of trainee - 1-3 months

Work Location (Address): Work at Home - Nationwide.

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.

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com