[Hiring] Referrals Coordinator @Humana

Role Description

As a Referrals Coordinator, you will perform data entry into the 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 sensitive diagnoses and/or referrals requiring Case Management, and sends to the 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 referrals.
• Requires assigning appropriate ICD10 codes to referrals as well as appropriate CPT Codes.
• 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 processes referrals from Military Treatment Facilities (MTFs) and civilian providers. The Referrals Coordinator performs basic administrative/clerical/operational/customer support/computational tasks.

• 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.

Qualifications

• High school diploma or equivalent
• UM/Coding experience and/or medical terminology
• Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing)

Requirements

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

Benefits

• Medical, dental, and vision benefits
• 401(k) retirement savings plan
• Time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• Short-term and long-term disability
• Life insurance
• Many other opportunities

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full-time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job-related skills, knowledge, experience, education, certifications, etc.

$39,000 - $49,400 per year

This job is eligible for a bonus incentive plan based on company and/or individual performance.