What are the responsibilities and job description for the Referrals Coordinator position at Humana?
Become a part of our caring community and help us put health first
The Referrals Coordinator 2 process referrals from Military Treatment Facilities (MTFs) and civilian providers. The Referrals Coordinator 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.The Referrals Coordinator 2 handles some inbound calls, performs data entry into the medical management system, assigning an appropriate provider, reviewing for benefits, and/or medical necessity as required or pending to a nurse or supervisor who can complete or request additional information.
Role Responsibilities
Recognizes a sensitive diagnosis and/or referral requiring Case Management and pend 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 code to referral as well as appropriate CPT Code.
Decisions are typically focus on interpretation of area/department policy and methods for completing assignments.
Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction.
Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.
Use your skills to make an impact
Required Qualifications
Our Department of Defense Contract requires U.S. citizenship for this position
Successfully receive interim approval for government security clearance (NBIS - National Background Investigation Services)
2 plus years of customer service experience AND/OR administrative/data entry experience
2 plus years of healthcare experience with Intermediate working knowledge using medical terminology, CPT and ICD codes
Strong telephonic customer service skills to include active listening, interpersonal and rapport building, patient and empathetic attitude and trouble shooting skills
Must be able to work autonomously and be self-driven
Must meet be able to meet productivity metrics
Expertise with MS Office products (Outlook, Word, PowerPoint, Excel) and ability to easily navigate multiple computer applications
The ability and willingness to work an 8-hour shift between the hours of 8 a.m. to 5 p.m. Eastern Standard Time (EST) and some potential overtime (Based on business need)
Preferred Qualifications
Veteran or Military Spouse
Individuals with an understanding of TRICARE benefits/limitations, Humana Military referral processes, MOUs with MTFs, and referral and UM policies.
College degree
Experience in a Managed Care setting
Advanced experience with medical terminology and ICD10 codes
Additional Information
Training:
Performed virtually, with length of training depending on progression of trainee - 1 - 2 months
Work at Home/Remote Requirements
To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
Satellite, cellular and microwave connection can be used only if approved by leadership
Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
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 year
Description of Benefits
About us
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.
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.
Salary : $39,000 - $49,400