Referrals Coordinator

Humana

. Perform data entry into the medical management system .

Posted 10/2/2026full-timeRemote • United StatesMid-LevelSenior💰 $39,000 - $49,400 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in data entry, referral processing, and medical coding, with a strong understanding of TRICARE benefits and Humana Military referral processes. Capable of maintaining compliance with HIPAA regulations while providing exceptional customer support and managing sensitive information.

Highest-signal resume keywords

Data EntryReferral ProcessingICD10 CodingCPT CodingTRICARE Benefits Knowledge

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Data EntryReferral ProcessingICD10 CodingCPT CodingMedical TerminologyUM/Coding ExperienceReport PreparationFile MaintenanceProcess ImprovementContingency Operations

Soft Skills

Customer SupportCommunicationProblem-SolvingAttention to DetailAdaptability

Tools & Technologies

Medical Management SystemMSRMTF Systems

Certifications & Qualifications

Government Security Clearance (eQIP)

Industry Keywords

TRICAREHumana MilitaryMilitary Health CarePHIHIPAA

About the role

Key responsibilities & impact

Perform data entry into the medical management system
Assign appropriate providers
Review referrals for benefits
Pend referrals to a nurse or supervisor for medical necessity review or additional information
Recognize sensitive diagnoses and referrals requiring Case Management and route them appropriately
Apply knowledge of TRICARE benefits and limitations, Humana Military referral processes, MOUs with MTFs, and referral and UM policies
Answer questions and contact MTFs or civilian providers to obtain additional information
Assign appropriate ICD10 and CPT codes to referrals
Process referrals and authorizations according to cycle-time and quality standards, including contingency operations
Enter information into MSR and other required systems
Update beneficiary contact information accurately and promptly
Prepare and submit reports of findings
Maintain complete and accurate files
Respond to unexpected operational needs
Complete assigned projects and duties
Participate in process and performance improvement activities
Process referrals from Military Treatment Facilities and civilian providers under direct clinical supervision
Perform routine administrative, clerical, operational, customer support, and computational tasks

Requirements

What you’ll need

High school diploma or equivalent
UM/Coding experience and/or medical terminology
U.S. citizenship required by the Department of Defense Contract
Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing)
Minimum home internet speed of 25 Mbps download and 10 Mbps upload
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Preferred: 2 years prior Humana Government Business experience
Preferred: 3 years of experience in public contact position
Preferred: Associate or Bachelor’s Degree
Preferred: Military health care service experience or working knowledge of TRICARE entitlement program

Benefits

Comp & perks

Bonus incentive plan based upon company and/or individual performance
Medical benefits
Dental benefits
Vision benefits
401(k) retirement savings plan
Paid time off
Company holidays
Personal holidays
Paid parental leave
Paid caregiver leave
Short-term disability
Long-term disability
Life insurance
Dedicated home workspace arrangement
Remote work arrangement
Occasional travel to Humana offices for training or meetings