Referral Authorization Coordinator Lead

Profile

Description

Responsibilities

The ACD Referral Authorization Coordinator Lead role will assist the Supervisor in oversight & monitoring of processing and timeliness standards for referrals and authorizations under the Autism Care Demonstration (ACD). Under direct clinical supervision, process referrals from Military Treatment Facilities (MTFs) and civilian providers, assumes ownership and leads advanced and highly specialized administrative/operational

/customer support duties that require independent initiative and judgment. Activities do not require evaluation or interpretation of clinical information. Responsibilities also include data entry into medical management systems, assigning appropriate providers as necessary, reviewing referrals/authorizations for benefit coverage, and, as required, pending to an Autism Services Navigator (ASN), Utilization Management professional or Manager for clinical interpretations or determining the necessity for additional information and/or provider out reach. Assist in ensuring TRICARE beneficiaries receive the highest quality health care for Autism Spectrum Disorder (ASD) related services.

Humana Government Business government contract requires U.S. citizenship for this position .

KEY ACCOUNTABILITIES

50 % Conducts random audits, monitors and completes referrals/authorizations to ensure efficient operations in accordance with established cycle time and quality standards; enters information into MSR and other required/applicable systems. Serves as SME, answers questions or contacts MTFs and/or civilian providers to obtain additional information that may be required to complete referrals and assign appropriate ICD 10 codes to referrals or authorizations, as well as appropriate CPT codes. Makes decisions regarding the daily priorities for the administrative work group and/or external vendors including coordinating work activities and monitoring progress towards schedules/goals, and often oversees work of others and/or is the primary administrative owner of a main process, program, product or technology. Works within broad guidelines with little oversight.

30 % Utilizes un-activated reports to contact beneficiaries to ensure appointment availability within access to care standards; documents waitlists as appropriate; documents beneficiary choice in waiting for providers as appropriate. Monitors activated referral/authorization reports. Identifies access issues from available data and/or as reported by beneficiaries or other customers; prepares and submits reports of findings in accordance with defined requirements and maintains complete and accurate files related to assigned activities; discuss trends with leaders.

10 % Support leadership in communicating effectively with other departments to coordinate needs of beneficiaries, exhibits Humana's values at all times, communicates to support the goals of the ACD. Ensures coordination between referral management and utilization management to maintain performance standards at all times. Assist leadership in process improvement initiatives to ensure optimal performance.

10% Performs timely and accurate data entry of changes to beneficiary contact information in accordance with established department procedures. May require rebuilding referrals and authorizations, maintaining knowledge of routing procedures appropriate for type of service requested.

This role description in no way states or implies that the key accountabilities above are the only ones being performed by the individual(s) with this role description. The individual(s) may be called upon and required to follow other instructions or perform other duties and tasks requested by his or her supervisor, consistent with the purpose of the position, department and/or company objectives .

Required Qualifications

Healthcare professional with a minimum of a Bachelor's degree in social work, psychology, or related health discipline from an accredited University

Ability to handle high volume of calls and customer contacts in a polite and professional manner

Strong organizational skills and ability to effectively manage multiple activities

Above average written and verbal skills, including organizational abilities

Computer experience including data entry

Ability to handle multiple projects simultaneously and to prioritize appropriately

Experience with Microsoft Office products including; Word, Excel and/or PowerPoint

Demonstrates initiative and attention to detail

Evident problem solving skills utilizing available resources

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)

Work at Home Requirements

Must have a separate room with a locked door that can be used as a home office to ensure you have absolute and continuous privacy while you work

Must provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required

Preferred Qualifications

Military health care service experience or working knowledge of the ACD and other TRICARE programs

Minimum three years' experience working in a clinic, hospital, managed care, or other healthcare setting

Knowledge of Autism Spectrum Disorder, specifically about Applied Behavior Analysis and other related therapies

Additional Information

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 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

Company info

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