Referrals Coordinator

Humana

. Handle inbound calls . Perform data entry into the medical management system . Assign appropriate providers . Review referrals for benefits and/or medical necessity . Pend tasks to a nurse or supervisor when additional

Posted 10/14/2026full-timeRemote • United StatesJuniorMid-Level💰 $39,000 - $49,400 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in medical terminology, CPT, and ICD coding while effectively managing referrals and data entry in a healthcare environment. Proficient in navigating multiple computer applications and maintaining compliance with HIPAA regulations.

Highest-signal resume keywords

Healthcare ExperienceCustomer Service ExperienceICD-10 CodingCPT CodingMS Office Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Data EntryMedical TerminologyICD-10 CodingCPT CodingReferral ManagementCase ManagementBenefits ReviewTask AssignmentInterpersonal CommunicationProblem Solving

Soft Skills

Attention to DetailOrganizational SkillsTime ManagementAdaptabilityCommunication Skills

Tools & Technologies

Medical Management SystemMS Office (Outlook, Word, PowerPoint, Excel)Computer Applications

Certifications & Qualifications

U.S. CitizenshipGovernment Security Clearance (NBIS)

Industry Keywords

TRICARE BenefitsHumana Military Referral ProcessesMTFReferral PoliciesUM PoliciesPHIHIPAA Compliance

About the role

Key responsibilities & impact

Handle inbound calls
Perform data entry into the medical management system
Assign appropriate providers
Review referrals for benefits and/or medical necessity
Pend tasks to a nurse or supervisor when additional review or information is needed
Recognize sensitive diagnoses or referrals requiring Case Management and route them for review
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 referral information
Assign appropriate ICD-10 and CPT codes to referrals
Report to a Supervisor of Referrals

Requirements

What you’ll need

U.S. citizenship required
Successfully receive interim approval for government security clearance (NBIS - National Background Investigation Services)
Must not currently live in Puerto Rico
2 years of customer service experience and/or administrative/data entry experience
2 years of healthcare experience
Intermediate working knowledge of medical terminology, CPT, and ICD codes
Expertise with MS Office products (Outlook, Word, PowerPoint, Excel)
Ability to navigate multiple computer applications
Ability to work an 8-hour shift between 8 a.m. and 5 p.m. Eastern Standard Time, with potential overtime
Internet service with at least 25 Mbps download and 10 Mbps upload speed
Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information

Benefits

Comp & perks

Bonus incentive plan based on company and/or individual performance
Medical, dental, and vision benefits
401(k) retirement savings plan
Paid time off
Company and personal holidays
Paid parental and caregiver leave
Short-term and long-term disability
Life insurance
Occasional travel to Humana offices for training or meetings may be required