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

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.

Responsibilities

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

40