The Referrals Coordinator 1 process referrals from Military Treatment Facilities (MTFs) and civilian providers. The Referrals Coordinator 1 performs basic administrative/clerical/operational/customer support/computational tasks. Typically works on routine and patterned assignments.
The Referrals Coordinator 1 includes data entry into medical management system, assigning an appropriate provider, reviewing for benefits, and/or medical necessity as required or pending to a nurse or supervisor who can complete or request additional information. Recognizes a sensitive diagnoses and/or referral requiring Case Management, and pend to appropriate point of contact for review. Understands TRICARE benefits/limitations and Humana Military referral processes, MOUs with MTFs, and referral and UM policies. Answers questions or contacts MTFs and/or civilian providers to obtain additional information that may be required to complete referral etc. Requires assigning appropriate ICD10 code to referral as well as appropriate CPT Code. Decisions are limited to defined parameters around work expectations, quality standards, priorities and timing, and works under close supervision and/or within established policies/practices and guidelines with minimal opportunity for deviation.
- High school diploma or GED
- 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)
- 3 years experience in a public contact position
- The ability and willingness to work an 8-hour shift between the hours of 7:30 a.m. to 4:30 p.m EST Monday through Friday
- Ability to handle of calls and customer contacts in a polite and professional manner
- Above average written and verbal skills including organizational abilities
- Proficient in MS Office Products (Outlook, Word, PowerPoint, Excel)
- Strong attention to detail
- Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) is required
- A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
- UM/Coding experience and/or medical terminology
- Experience/knowledge of ICD-10 Coding
- Military health care service experience or working knowledge of TRICARE entitlement program
- Prior healthcare/insurance experience
- Associate or Bachelor's Degree
As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire Text to enhance our hiring and decision-making ability. Modern Hire Text allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
If you are selected for a first round interview, you will receive a correspondence inviting you to participate in a Modern Hire Text interview. In this interview, you review a set of interview questions over your phone and you will provide text responses to each question. You should anticipate this interview to take about 15 to 20 minutes. Your text message interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Scheduled Weekly Hours