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 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.
+ 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**
+ 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
+ Experience in a managed care setting
+ Experience with medical terminology and ICD-10 codes
+ Health care experience
+ **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**
- Business Requirements
- Case Management
- Customer Relationship Management
- Customer Service
- Data Entry