Referrals Coordinator

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $39k - $49.4k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Handle inbound calls • Perform data entry into the medical management system • Assign appropriate providers • Review referrals for benefits and/or medical necessity • Pend tasks to a nurse or supervisor when additional review or information is needed • Recognize sensitive diagnoses or referrals requiring Case Management and route them for review • Apply knowledge of TRICARE benefits and limitations, Humana Military referral processes, MOUs with MTFs, and referral and UM policies • Answer questions and contact MTFs or civilian providers to obtain additional referral information • Assign appropriate ICD-10 and CPT codes to referrals • Report to a Supervisor of Referrals

🎯 Requirements

• U.S. citizenship required • Successfully receive interim approval for government security clearance (NBIS - National Background Investigation Services) • Must not currently live in Puerto Rico • 2 years of customer service experience and/or administrative/data entry experience • 2 years of healthcare experience • Intermediate working knowledge of medical terminology, CPT, and ICD codes • Expertise with MS Office products (Outlook, Word, PowerPoint, Excel) • Ability to navigate multiple computer applications • Ability to work an 8-hour shift between 8 a.m. and 5 p.m. Eastern Standard Time, with potential overtime • Internet service with at least 25 Mbps download and 10 Mbps upload speed • Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information

🏖️ Benefits

• Bonus incentive plan based on company and/or individual performance • Medical, dental, and vision benefits • 401(k) retirement savings plan • Paid time off • Company and personal holidays • Paid parental and caregiver leave • Short-term and long-term disability • Life insurance • Occasional travel to Humana offices for training or meetings may be required