Job Details

Referrals Coordinator 2/HGB Health Care exp. Work at Home Nationwide

Company name
Humana Inc.

Location
Albuquerque, NM, United States

Employment Type
Full-Time

Industry
Work At Home, Healthcare, Administrative

Posted on
Apr 20, 2021

Apply for this job






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

High School Diploma

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

Work Location (Address): WAH 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

Similar Jobs:
Job Information Humana Manager, Utilization Management Nursing - Medicare / Medicaid in Albuquerque New Mexico Description The Manager, Utilization Management Nursing utilizes clinical nursing skills to support the coordination, d...
Job Information Humana Associate VP, Technology Solutions, Pharmacy in Albuquerque New Mexico Description The Associate Vice President of Technology Solutions acts as a liaison and collaborates with the business and functional sta...
Coder - Outpatient - PRN
Location : Rio Rancho, NM
Coder - Outpatient - PRN Department: Patient Financial Services Location: Rio Rancho, NM START YOUR APPLICATION Job Summary and Scope As assigned Code outpatient and day surgery records for the purpose of reimbursement, research a...
EmploymentCrossing is great because it brings all of the jobs to one site. You don't have to go all over the place to find jobs.
Kim Bennett - Iowa,
  • All we do is research jobs.
  • Our team of researchers, programmers, and analysts find you jobs from over 1,000 career pages and other sources
  • Our members get more interviews and jobs than people who use "public job boards"
Shoot for the moon. Even if you miss it, you will land among the stars.
HealthcareCrossing - #1 Job Aggregation and Private Job-Opening Research Service — The Most Quality Jobs Anywhere
HealthcareCrossing is the first job consolidation service in the employment industry to seek to include every job that exists in the world.
Copyright © 2024 HealthcareCrossing - All rights reserved. 21 192