Referrals Coordinator

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $39k - $49.4k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 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

• Perform data entry into the medical management system • Assign appropriate providers • Review referrals for benefits • Pend referrals to a nurse or supervisor for medical necessity review or additional information • Recognize sensitive diagnoses and referrals requiring Case Management and route them appropriately • 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 information • Assign appropriate ICD10 and CPT codes to referrals • Process referrals and authorizations according to cycle-time and quality standards, including contingency operations • Enter information into MSR and other required systems • Update beneficiary contact information accurately and promptly • Prepare and submit reports of findings • Maintain complete and accurate files • Respond to unexpected operational needs • Complete assigned projects and duties • Participate in process and performance improvement activities • Process referrals from Military Treatment Facilities and civilian providers under direct clinical supervision • Perform routine administrative, clerical, operational, customer support, and computational tasks

🎯 Requirements

• High school diploma or equivalent • UM/Coding experience and/or medical terminology • U.S. citizenship required by the Department of Defense Contract • Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing) • Minimum home internet speed of 25 Mbps download and 10 Mbps upload • Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information • Preferred: 2 years prior Humana Government Business experience • Preferred: 3 years of experience in public contact position • Preferred: Associate or Bachelor’s Degree • Preferred: Military health care service experience or working knowledge of TRICARE entitlement program

🏖️ Benefits

• Bonus incentive plan based upon company and/or individual performance • Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Dedicated home workspace arrangement • Remote work arrangement • Occasional travel to Humana offices for training or meetings