Referrals Coordinator

Summary

Humana is a healthcare company serving individuals, families, military personnel, and communities. The Referrals Coordinator processes medical referrals and authorizations, performs data entry, assigns providers and coding, verifies benefits, and coordinates additional clinical review or information requests. The role also maintains records, prepares reports, and supports operational and performance improvement activities.

Responsibilities

• Processes referrals/authorizations in accordance with established cycle time and quality standards including during contingency operations. Enters information into MSR computer and other required/applicable systems
• Performs timely and accurate data entry of changes to beneficiary contact information in accordance with established department procedures
• Prepares and submits reports of findings in accordance with requirements defined by the supervisor and maintains complete and accurate files related to assigned activities
• Becomes proficient in a variety of skills that enables the associate to respond to unexpected operational needs. Accomplishes other projects and duties as assigned. Participates in process and performance improvement activities

Skills

• High school diploma or equivalent
• UM/Coding experience and/or medical terminology
• 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 years prior Humana Government Business experience
• 3 years of experience in public contact position
• Associate or Bachelor's Degree
• Military health care service experience or working knowledge of TRICARE entitlement program

Qualifications

Must Haves

• High school diploma or equivalent
• UM/Coding experience and/or medical terminology
• 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)

Nice to Haves

• 2 years prior Humana Government Business experience
• 3 years of experience in public contact position
• Associate or Bachelor's Degree
• Military health care service experience or working knowledge of TRICARE entitlement program

Benefits

• This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
• Medical benefits
• Dental benefits
• Vision benefits
• 401(k) retirement savings plan
• Paid time off
• Company holidays
• Personal holidays
• Paid parental leave
• Paid caregiver leave
• Short-term disability
• Long-term disability
• Life insurance
• Remote position