New job Referral Coordinator 2/HGB - Work at Home Nationwide in Texas

Referral Coordinator 2/HGB - Work at Home Nationwide

Company : Humana
Salary : Details not provided
Location : Texas

Full Description

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.

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
  • 2 - 3 years Customer Service skills
  • 2 - 3 years administrative/data entry experience
  • 2 - 3 years healthcare experience
  • Must be able to work autonomously and be self-driven
  • Must meet be able to meet productivity metrics
  • 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
  • Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing)
  • Work at Home requirements: Must ensure designated work area is free from distractions during work hours and virtual meetings. Must provide a high-speed DSL or cable modem for a workspace (Satellite and Hotspots are prohibited). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) for optimal performance of is required

Preferred Qualifications

  • College degree
  • Experience in a Managed Care setting
  • Experience with medical terminology and ICD10 codes
  • Flexibility with schedule

Additional information

  • Schedule: Monday-Friday from 8:00 am-5:00 pm CST. Overtime may be required and some weekends depending on workload
  • Training: Training will be done virtually, with length of training depending on progression of trainee - 1-3 months
  • Work Location (Address): Work at Home - Nationwide.
  • Will be eligible for P4P (Pay for Performance): New hires must successfully complete the 90 day or extended probationary period to qualify for the next cycle.

Scheduled Weekly Hours


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