Referrals Coordinator

Become a part of our caring community As a Referrals Coordinator, you will perform data entry into medical management system, assigning an appropriate provider, reviewing for benefits, and as required pending to a nurse or supervisor who can complete the medical necessity review or request additional information. Recognizes a sensitive diagnoses and/or referral requiring Case Management, and send 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 codes to referral as well as appropriate CPT Codes. Decisions are limited to defined parameters around work expectations, quality standards, priorities, and timing. Works under close clinical supervision and/or within established policies/practices and guidelines with minimal opportunity for deviation Under direct clinical supervision, the Referrals Coordinator 2 process referrals from Military Treatment Facilities (MTFs) and civilian providers. …