Remote Referrals Coordinator | Healthcare Data Entry Pro

Humana Inc; Honolulu (HI); Remote; USD 39,000 - 49,000; Full time

Job summary

Humana Inc. is seeking a Remote Referrals Coordinator who will handle inbound calls, perform data entry into the medical management system, and assign providers. You will review benefits and medical necessity and may pend tasks to a nurse or supervisor when needed.

Responsibilities include recognizing referrals needing Case Management, understanding TRICARE policies, and communicating with MTFs and providers to gather information. Requires healthcare terminology knowledge and CPT/ICD coding.

Qualifications

• U.S. citizenship required due to DoD contract.
• Interim approval for NBIS security clearance required.
• Not authorized to hire candidates living in Puerto Rico.
• 2 years of customer service and/or administrative/data entry experience.
• 2 years of healthcare experience with CPT and ICD coding knowledge.
• Proficiency in MS Office and ability to navigate multiple applications.
• Ability to work an 8-hour shift 8 a.m.–5 p.m. EST; some overtime may be required.

Responsibilities

• Recognize a sensitive diagnosis/referral for Case Management and pend for review.
• Understand TRICARE benefits/limitations and Humana Military referral processes, MOUs with MTFs, and referral/UM policies.
• Answer questions or contact MTFs and civilian providers to obtain referral information.
• Assign appropriate ICD-10 and CPT codes to referrals.

Skills

Customer service

Administrative/data entry

Healthcare terminology

ICD-10/CPT coding

MS Office proficiency

Multitasking / navigation of multiple

Tools

MS Office Suite

Job description

Humana Inc. is seeking a Remote Referrals Coordinator who will handle inbound calls, perform data entry into the medical management system, and assign providers. You will review benefits and medical necessity and may pend tasks to a nurse or supervisor when needed.

Responsibilities include recognizing referrals needing Case Management, understanding TRICARE policies, and communicating with MTFs and providers to gather information. Requires healthcare terminology knowledge and CPT/ICD coding.