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Referrals Coordinator 2/ HGB – Work at Home


This is a Full-time position in Las Vegas, NV posted September 20, 2022.

Description The Referrals Coordinator 2 process referrals from Military Treatment Facilities (MTFs) and civilian providers.

The Referrals Coordinator 2 performs varied activities and moderately complex administrative/operational/customer support assignments.

Performs computations.

Typically works on semi-routine assignments.

Responsibilities Job Description The Referrals Coordinator 2 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.

Role Responsibilities 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 typically focus on interpretation of area/department policy and methods for completing assignments.

Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction.

Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.

Our Department of Defense Contract requires U.S.

citizenship for this position Required Qualifications 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) High School Diploma or college degree preferred.

Excellent customer relations skills 2 years administrative/data entry experience Expertise with MS Office products and ability to easily navigate multiple computer applications Must be passionate about contributing to an organization focused on continuously improving consumer experiences Work at Home Requirements: Must have a separate room with a locked door that can be used as a home office, to ensure you and your patients have absolute and continuous privacy while you work.

Must have accessibility to high speed DSL or Cable modem for a home office (No Satellite).

Must be available to work Monday through Friday hours dependent on location and will be at least 8 hours a day between 7:00 am to 7:00 pm Preferred Qualifications Experience in a managed care setting Experience with medical terminology and ICD-10 codes Health care experience Additional information Schedule: Monday to Friday from 8 am to 4:30 pm.

OR, 5:00 pm depending on lunch time 30 vs 60 minutes.

Overtime as per business needs.

Training: It will be done virtually; 3-6 months.

Work Location (Address): WAH Nationwide.

Scheduled Weekly Hours 40