Remote Referrals Coordinator (Healthcare/MTF)

Humana Inc; Montgomery (AL); Remote; USD 39,000 - 49,000; Full time

Benefits offered by this job

Medical, dental and vision benefits

401(k) retirement savings plan

Paid time off

Life insurance

Job summary

Humana Inc. is seeking a Remote Referrals Coordinator to support Humana Military and beneficiaries. You will handle inbound calls, perform data entry in the medical management system, and review benefits and/or medical necessity.

You will pend to a nurse or supervisor as needed to obtain additional information. Responsibilities include recognizing sensitive diagnoses for Case Management, understanding TRICARE processes, contacting MTFs and providers, and assigning ICD10/CPT codes to referrals.

Qualifications

• 2 years of customer service experience AND/OR administrative/data entry experience.
• 2 years of healthcare experience with Intermediate working knowledge using medical terminology, CPT and ICD codes.
• Expertise with MS Office products (Outlook, Word, PowerPoint, Excel) and ability to easily navigate multiple computer applications.
• The ability to work an 8‑hour shift between 8 a.m. to 5 p.m. Eastern Standard Time (EST) and some potential overtime (Based on business need)

Responsibilities

• You will recognize a sensitive diagnosis and/or referral requiring Case Management and pend to appropriate contact for review.
• You will understand TRICARE benefits/limitations and Humana Military referral processes, MOUs with MTFs, and referral and UM policies.
• You will answer questions or contact MTFs and civilian providers to obtain additional information for referrals
• You will assign appropriate ICD10 code to referral and appropriate CPT Code.

Skills

Customer service

Healthcare terminology

Data entry

MS Office

EST hours

Tools

MS Office

Job description

Humana Inc. is seeking a Remote Referrals Coordinator to support Humana Military and beneficiaries. You will handle inbound calls, perform data entry in the medical management system, and review benefits and/or medical necessity.

You will pend to a nurse or supervisor as needed to obtain additional information. Responsibilities include recognizing sensitive diagnoses for Case Management, understanding TRICARE processes, contacting MTFs and providers, and assigning ICD10/CPT codes to referrals.