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Referral Coordinator 2 (Humana Government Business)

Company: Humana
Location: Sandy
Posted on: June 18, 2022

Job 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.

**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:**


+ 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


+ Performed virtually, with length of training depending on progression of trainee - 1-3 months


+ 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**


Keywords: Humana, Sandy , Referral Coordinator 2 (Humana Government Business), Government & Protective Services , Sandy, Utah

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