About the role
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 deviationUnder 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.
Our Department of Defense Contract requires U.S. citizenship for this position
Use your skills to make an impact
Required Qualifications
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)
Preferred Qualifications
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.Scheduled Weekly Hours
40Pay 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 yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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 and many other opportunities.
About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Originally posted on Himalayas