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Referrals Coordinator 2/ HGB - Work at Home at Humana

Referrals Coordinator 2/ HGB - Work at Home

Humana Charlotte, NC (Remote) Full-Time

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.


**Job Description**

The Referrals Coordinator 2 includes data entry into 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 diagnoses 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.

+ **Our Department of Defense Contract requires U.S. citizenship for this position**

**Required Qualifications**

+ 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)

+ High School Diploma or college degree preferred.

+ Excellent customer relations skills

+ 2 years administrative/data entry experience

+ Expertise with MS Office products and ability to easily navigate multiple computer applications

+ Must be passionate about contributing to an organization focused on continuously improving consumer experiences

+ **Work at Home Requirements:** Must have a separate room with a locked door that can be used as a home office, to ensure you and your patients have absolute and continuous privacy while you work. Must have accessibility to high speed DSL or Cable modem for a home office (No Satellite).

+ Must be available to work Monday through Friday hours dependent on location and will be at least 8 hours a day between 7:00 am to 7:00 pm

**Preferred Qualifications**

+ Experience in a managed care setting

+ Experience with medical terminology and ICD-10 codes

+ Health care experience

**Additional information**

+ **Schedule:** Monday to Friday from 8 am to 4:30 pm. OR, 5:00 pm depending on lunch time 30 vs 60 minutes. Overtime as per business needs.

+ **Training:** It will be done virtually; 3-6 months.

+ **Work Location (Address): WAH Nationwide.**

**Scheduled Weekly Hours**


Recommended Skills

  • Administration
  • Business Requirements
  • Case Management
  • Customer Relationship Management
  • Customer Service
  • Data Entry
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Job ID: 1970005606

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