Referral Coordinator 2 (Humana Government Business)
Company: Humana
Location: Sandy
Posted on: June 18, 2022
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Job Description:
**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.
**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.
**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 - 3 years Customer Service
+ 2 - 3 years administrative/data entry experience
+ 2 - 3 years 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 and ability to easily navigate
multiple computer applications
+ We will require---full COVID vaccination for this job as we are
a---healthcare---company committed to putting health and safety
first for our members, patients, associates, and the communities we
serve.
+ If progressed to offer, you will be required to provide proof of
full vaccination where allowed by law. Medical and religious
exemptions will be considered on a case-by-case basis.
**Preferred Qualifications**
+ Veterans or Military Spouses
+ 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:**
**Schedule**
+ Must be able to work an 8 hour shift Monday through Friday
anywhere from 7 AM to 6 PM Central Time zone.
+ Overtime may be required and some weekends depending on business
need
**Training**
+ Performed virtually, with length of training depending on
progression of trainee - 1-3 months
**Workstyle**
+ Remote work at home
+ WAH requirements: Must have the ability to provide a high speed
DSL or cable modem for a home office. Associates or contractors who
live and work from home in the state of California will be provided
payment for their internet expense.
+ A minimum standard speed for optimal performance of 25x10 (25mpbs
download x 10mpbs upload) is required.
+ Satellite and Wireless Internet service is NOT allowed for this
role.
+ A dedicated space lacking ongoing interruptions to protect member
PHI / HIPAA information
**Work Location**
+ Nationwide, excluding Alaska and Hawaii
**Benefits Start Upon Date of Hire**
+ Medical, Dental, Vision
+ 401K/Roth 6% match at 125% & fully vested after 2 years
+ 23 days accrued PTO
+ 7 major recognized holidays
+ 5 additional holidays
+ 1 volunteer day
+ Education reimbursement
**Eligible for P4P (Pay for Performance)**
+ Incentive Pay of up to 10% base compensation rate per quarter
+ New hires must successfully complete the 90 day or extended
probationary period to qualify for the next cycle.
**Interview Format**
As part of our hiring process for this opportunity, we will be
using an exciting screening and interviewing technology called
Modern Hire to enhance our hiring and decision-making ability. We
use this technology to gain valuable information from you
pertaining to your relevant skills and experience at a time that is
best for your schedule.
You will be able to respond to the recruiters preferred response
method via text, video or voice technologies If you are selected
for a screen, you may receive an email correspondence **(please be
sure to check your spam or junk folders often to ensure
communication isn't missed)** inviting you to participate. You
should anticipate this screen to take about 15 to 30 minutes. Your
recorded screen will be reviewed and you will subsequently be
informed if you will be moving forward to next round of
interviews.
**Scheduled Weekly Hours**
40
Keywords: Humana, Sandy , Referral Coordinator 2 (Humana Government Business), Government & Protective Services , Sandy, Utah
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