Referrals Coordinator
New
H
HumanaHealthcare referrals
Source API remote eligibility restrictions: GeorgiaFull-TimeJunior
Salary$39,000 - $49,400 per year. This job is eligible for a bonus incentive plan.
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Job Details
- Experience
- 2 years prior Humana Government Business experience; 3 years of experience in public contact position
- Required Skills
- Data entry
Requirements
- High school diploma or equivalent.
- UM/coding experience and/or medical terminology.
- Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing).
- Preferred: 2 years of prior Humana Government Business experience.
- Preferred: 3 years of experience in a public contact position.
- Preferred: Associate or bachelor’s degree.
- Preferred: Military health care service experience or working knowledge of the TRICARE entitlement program.
- Meet the home internet requirements of at least 25 Mbps download and 10 Mbps upload.
- Work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information.
Responsibilities
- Process referrals and authorizations in accordance with established cycle-time and quality standards.
- Enter referral information into the MSR computer and other required systems.
- Perform timely and accurate data entry of changes to beneficiary contact information.
- Assign appropriate providers and ICD-10 and CPT codes to referrals.
- Review referral benefits and route cases requiring medical-necessity review or additional information to a nurse or supervisor.
- Recognize sensitive diagnoses and referrals requiring Case Management and send them to the appropriate point of contact.
- Answer questions and contact MTFs or civilian providers to obtain information needed to complete referrals.
- Prepare reports of findings and maintain complete and accurate files.
- Participate in process and performance improvement activities and support unexpected operational needs.
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