Referrals Coordinator

Referrals Coordinator 2

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 pends 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 :

Preferred Qualifications :

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 :

Scheduled Weekly Hours 40

Pay 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 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

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.