Humana Inc. is hiring a Referrals Coordinator

CenterWell Pharmacy is hiring a Referrals Coordinator to join our team. In this role, you will process referrals from Military Treatment Facilities (MTFs) and civilian providers, ensuring members are connected to appropriate care. You'll perform varied administrative and customer support assignments using medical management systems, all while contributing to our mission of putting health first.

What You'll Do

• Process referrals from Military Treatment Facilities (MTFs) and civilian providers.
• Handle inbound calls, perform data entry into the medical management system, and assign an appropriate provider.
• Review referrals for benefits and/or medical necessity as required.
• Recognize sensitive diagnoses and/or referrals requiring Case Management and pend to the appropriate point of contact for review.
• Answer questions or contact MTFs and/or civilian providers to obtain additional information required to complete referrals.
• Assign appropriate ICD10 and CPT codes to referrals.
• Work within defined parameters to identify work expectations and quality standards with some latitude over prioritization and timing.
• Follow standard policies and practices that allow for some opportunity for interpretation, deviation, and independent discretion.

What We're Looking For

• U.S. citizenship (Department of Defense contract requirement).
• Ability to successfully receive interim approval for a government security clearance (NBIS - National Background Investigation Services).
• 2+ years of customer service experience and/or administrative or data entry experience.
• 2+ years of healthcare experience with intermediate working knowledge using medical terminology, CPT, and ICD codes.
• Strong telephonic customer service skills including active listening, interpersonal and rapport building, patient and empathetic attitude, and troubleshooting skills.
• Must be able to work autonomously and be self-driven.
• Must be able to meet productivity metrics.
• Expertise with MS Office products (Outlook, Word, PowerPoint, Excel) and ability to easily navigate multiple computer applications.
• Ability and willingness to work an 8-hour shift between 8 a.m. to 5 p.m. Eastern Standard Time (EST) with some potential overtime.

Nice to Have

• Veteran or Military Spouse.
• Understanding of TRICARE benefits/limitations, Humana Military referral processes, MOUs with MTFs, and referral and UM policies.
• College degree.
• Experience in a Managed Care setting.
• Advanced experience with medical terminology and ICD10 codes.

Technical Stack

• MS Office (Outlook, Word, PowerPoint, Excel)
• Medical management system

Benefits & Compensation

• Compensation range: $39,000 - $49,400 per year.
• Medical, dental and vision benefits.
• 401(k) retirement savings plan.
• Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave).
• Short-term and long-term disability.
• Life insurance.

Work Mode

This is a fully remote position.

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.