Humana ir veselības aprūpes un veselības apdrošināšanas uzņēmums, kas koncentrējas uz veselības rezultātu uzlabošanu indivīdiem, kopienām un plašākai veselības aprūpes sistēmai. Uzņēmuma darbība ietver Medicare Advantage HMO, PPO un PFFS plānus, kas apkalpo, cita starpā, seniorus un militārpersonas. Humana uzsver arī iekļaujošu darba vidi, kuras pamatā ir piederības sajūta, savstarpēja cieņa un darbinieku iespējas sniegt ieguldījumu uzņēmuma misijā, kas vērsta uz veselību.
Remote Referrals Coordinator – Humana
Coordinate Humana healthcare referrals remotely, including provider assignment, benefits review, and medical coding. Support TRICARE and Humana Military referral processes across the United States.
Apraksts
- Manage incoming calls.
- Enter information into the medical management system.
- Match referrals with appropriate providers.
- Review referrals for benefit coverage and medical necessity.
- Route pending tasks to a nurse or supervisor when more information or review is needed.
- Identify sensitive diagnoses and referrals that require Case Management, then send them for review.
- Use knowledge of TRICARE benefits and limitations, Humana Military referral processes, MTF memoranda of understanding, and referral and utilization management policies.
- Respond to questions and contact MTFs or civilian providers to gather missing referral details.
- Select appropriate ICD-10 and CPT codes for referrals.
- Report to the Supervisor of Referrals.
Prasības
- U.S. citizenship is required.
- Must receive interim approval for a government security clearance through NBIS (National Background Investigation Services).
- Applicants must not currently reside in Puerto Rico.
- At least two years of customer service and/or administrative or data entry experience.
- At least two years of healthcare experience.
- Intermediate knowledge of medical terminology, CPT, and ICD codes.
- Expertise with Microsoft Office applications, including Outlook, Word, PowerPoint, and Excel.
- Ability to use multiple computer applications.
- Availability for an eight-hour shift between 8 a.m. and 5 p.m. Eastern Time, with possible overtime.
- Internet service with minimum speeds of 25 Mbps download and 10 Mbps upload.
- A dedicated workspace without ongoing interruptions to protect member PHI and HIPAA information.
Priekšrocības
- Bonus incentive plan tied to company and/or individual performance.
- Medical, dental, and vision coverage.
- 401(k) retirement savings plan.
- Paid time off.
- Company and personal holidays.
- Paid parental and caregiver leave.
- Short-term and long-term disability coverage.
- Life insurance.
- Occasional travel to Humana offices for training or meetings may be required.