Humana
Location
Florida | United States
Job description
Referrals Coordinator Location Remote in Florida :
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 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
Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing)
2 plus years of customer service experience AND/OR administrative/data entry experience
2 plus years of healthcare experience with Intermediate working knowledge using medical terminology, CPT and ICD codes
Must be able to work autonomously and be self-driven
Must meet be able to meet productivity metrics
Expertise with MS Office products (Outlook, Word, PowerPoint, Excel) and ability to easily navigate multiple computer applications
Above average written and verbal skills including organizational abilities
Strong attention to detail
The ability and willingness to work an 8-hour shift sometime between the hours of 8 a.m. to 5 p.m. (Within your current time zone location) Monday through Friday and some potential overtime (Based on business need)
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:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
Satellite, cellular and microwave connection can be used only if approved by leadership
Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Preferred Qualifications
Veteran or Military Spouse
Individuals with an understanding of TRICARE benefits/limitations, Humana Military referral processes, MOUs with MTFs, and referral and UM policies.
College degree
Experience in a Managed Care setting
Advanced experience with medical terminology and ICD10 codes
Flexibility with schedule
Additional Information
Work Days/Hours :
Monday - Friday; must be able to work an 8-hour shift between 8:00 a.m. - 5 p.m. (Within your current/living time zone location)
Ability to work overtime depending on business needs
Training :
Performed virtually, with length of training depending on progression of trainee - 1-2 months
Interview Format As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
This is a remote position #LI-Remote
Scheduled Weekly Hours
40Pay 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 decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $34,500 - $47,400 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.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.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 because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
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