Referrals Coordinator

Become a part of our caring community

As a Referrals Coordinator, you will perform data entry into medical management system, assigning an appropriate provider, reviewing for benefits, and as required pending to a nurse or supervisor who can complete the medical necessity review or request additional information. Recognizes a sensitive diagnoses and/or referral requiring Case Management, and send 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 codes to referral as well as appropriate CPT Codes. Decisions are limited to defined parameters around work expectations, quality standards, priorities, and timing. Works under close clinical supervision and/or within established policies/practices and guidelines with minimal opportunity for deviation

Under direct clinical supervision, the Referrals Coordinator 2 process referrals from Military Treatment Facilities (MTFs) and civilian providers. The Referrals Coordinator performs basic administrative/clerical/operational/customer support/computational tasks. Typically works on routine and patterned assignments. Activities do not require evaluation or interpretation of clinical information.

Role Responsibilities

• Processes referrals/authorizations in accordance with established cycle time and quality standards including during contingency operations. Enters information into MSR computer and other required/applicable systems.
• Performs timely and accurate data entry of changes to beneficiary contact information in accordance with established department procedures.
• Prepares and submits reports of findings in accordance with requirements defined by the supervisor and maintains complete and accurate files related to assigned activities.
• Becomes proficient in a variety of skills that enables the associate to respond to unexpected operational needs. Accomplishes other projects and duties as assigned. Participates in process and performance improvement activities.

• High school diploma or equivalent
• UM/Coding experience and/or medical terminology
• 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)

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• 2 years prior Humana Government Business experience
• 3 years of experience in public contact position
• Associate or Bachelor's Degree
• Military health care service experience or working knowledge of TRICARE entitlement program.

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.