Referrals Coordinator 2/HGB Health Care exp. Work at Home Nationwide

Position Overview

The Referrals Coordinator 2 processes referrals from Military Treatment Facilities (MTFs) and civilian providers. This role performs varied activities and moderately complex administrative, operational, and customer support assignments, including computations and semi-routine tasks.

Key Responsibilities

• Data entry into the medical management system, assigning an appropriate provider, and reviewing for benefits and/or medical necessity before escalating to a nurse or supervisor.
• Recognizes a sensitive diagnosis and/or referral requiring Case Management and pends it to the appropriate point of contact for review.
• Understands TRICARE benefits/limitations, Humana Military referral processes, MOUs with MTFs, and referral and UM policies.
• Answers questions or contacts MTFs and civilian providers to obtain additional information required to complete the referral.
• Assigns appropriate ICD10 and CPT codes to referrals, with decisions focusing on interpretation of department policies and standard procedures.
• Works within defined parameters to identify work expectations and quality standards while maintaining some latitude over priority and timing under minimal direction.
• Follows standard policies and practices that allow for some independent discretion and interpretation/deviation when necessary.

Required Qualifications

• Our Department of Defense Contract requires U.S. citizenship for this position.
• High School Diploma.
• 2 - 3 years Customer Service skills.
• 2 - 3 years administrative/data entry experience.
• 2 - 3 years healthcare experience.
• Must be able to work autonomously and be self-driven.
• Must meet productivity metrics.
• Expertise with MS Office products and ability to navigate multiple computer applications.
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
• Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing).
• Work at Home requirements: Must ensure designated work area is free from distractions during work hours and virtual meetings; must provide a high-speed DSL or cable modem for the workspace (Satellite and Hotspots are prohibited) with a minimum standard speed of 10x1 (10mbs download x 1mbs upload) for optimal performance.

Preferred Qualifications

• College degree.
• Experience in a Managed Care setting.
• Experience with medical terminology and ICD10 codes.
• Flexibility with schedule.

Benefits & Perks

• Schedule: Monday-Friday from 8:00 am-5:00 pm CST. Overtime may be required and some weekends depending on workload.
• Location: WAH Nationwide.
• Training: Training will be done virtually, with the duration depending on the progress of the trainee.
• Scheduled Weekly Hours: 40.
• Eligible for P4P (Pay for Performance): New hires must successfully complete the 90-day or extended probationary period to qualify for the next cycle.