Referrals Coordinator

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<h2> <strong>Become a part of our caring community</strong><br> </h2><p>As a remote Referrals Coordinator, you will report to a Supervisor of Referrals. You will handle some inbound calls. You will perform data entry into the medical management system, assigning an appropriate provider. You will review for benefits and/or medical necessity as required. If necessary, you will pend the task to a nurse or supervisor who can complete or request additional information.</p><h2>Role Responsibilities</h2><ul> <li>You will recognize a sensitive diagnosis and/or referral requiring Case Management and pend to appropriate contact for review.</li> <li>You will understand TRICARE benefits/limitations and Humana Military referral processes, MOUs with MTFs, and referral and UM policies.</li> <li>You will answer questions or contact MTFs and civilian providers to obtain additional information for referrals</li> <li>You will assign appropriate ICD10 code to referral and appropriate CPT Code.</li> </ul><h2> <br><strong>Use your skills to make an impact </strong><br> </h2><h2>Required Qualifications</h2><ul> <li>Our Department of Defense Contract requires U.S. citizenship for this position</li> <li>Successfully receive interim approval for government security clearance (NBIS - National Background Investigation Services)</li> <li>HGB is not authorized to do work in Puerto Rico per our government contract. We are not able to hire candidates that are currently living in Puerto Rico.</li> <li>2 years of customer service experience <strong>AND/OR</strong> administrative/data entry experience</li> <li>2 years of healthcare experience with Intermediate working knowledge using medical terminology, CPT and ICD codes</li> <li>Expertise with MS Office products (Outlook, Word, PowerPoint, Excel) and ability to easily navigate multiple computer applications</li> <li>The ability to work an 8-hour shift between the hours of 8 a.m. to 5 p.m. Eastern Standard Time (EST) and some potential overtime (Based on business need)</li> </ul><h2>Preferred Qualifications</h2><ul> <li>Veteran or Military Spouse</li> <li>TRICARE experience, Humana Military referral processes, MOUs with MTFs, and referral and UM policies.</li> <li>Experience in a Managed Care setting</li> <li>Advanced experience with medical terminology and ICD10 codes</li> </ul><p><br><br>Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.</p><h2>Scheduled Weekly Hours</h2><p>40</p><h2>Pay Range</h2><p>The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$39,000 - $49,400 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.</p><h2>Description of Benefits</h2><p>Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 10-16-2026</p><h2> <br><strong>About us</strong><br> </h2><p>About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.</p><h2>​</h2><h2>Equal Opportunity Employer</h2><p>It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.</p><p>Apply directly on <a href="https://remotejobs.org">RemoteJobs.org</a>: https://remotejobs.org/remote-jobs/referrals-coordinator-humana</p>

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