Become a part of our caring community and help us put health first

The Supervisor, Referrals process referrals from Military Treatment Facilities (MTFs) and civilian providers. The Supervisor, Referrals works within thorough, prescribed guidelines and procedures; uses independent judgment requiring analysis of variable factors to solve basic problems; collaborates with management and top professionals/specialists in selection of methods, techniques, and analytical approach.

The Supervisor, Referrals 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. 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 are related to schedule, plans and daily operations. Performs escalated or more complex work of a similar nature, and supervises a group of typically support and technical associates; coordinates and provides day-to-day oversight to associates. Ensures consistency in execution across team. Holds team members accountable for following established policies.

Use your skills to make an impact

Job Duties

• Provides oversight, guidance and workflow of all Referral Coordinators and Health Information Management staff

• Works within thorough, prescribed guidelines and procedures

• Uses independent judgment requiring analysis of variable factors to solve basic problems

• Collaborates with management and top professionals/specialists in selection of methods, techniques, and analytical approach

• Schedules and pre-registers patients for exams and procedures with specialists and providers outside of the primary care physician's office

• Gathers and communicates all relative information and preparation instructions to patient and referring providers.

• Makes decisions based on schedule, plans and daily operational needs

• Performs escalated or more complex work of a similar nature, and supervises a group of typically support and technical associates

• Coordinates and provides day-to-day oversight to associates.

• Ensures consistency in execution across team.

• Holds team members accountable for following established policies.

• Analyzes and protects digital and traditional medical information vital to patient continuity of care

• Resolves conflicts (patient and associates) in timely manner

Preferred Qualifications

ICD-10 Certification

CRC Certification through AAPC

MRA and HEDIS knowledge

Required Qualifications

Associate's Degree 4 - 6 years in a physician office, health care, or managed care environment Certified Medical Coder with one of the following active certifications and with a high degree of competency (CPC, CPC-H, or CPMA from AAPC; or CCA, CCSP, CCS from AHIMA) Strong experience in ICD-9, ICD-10 and CPT coding Prior management or supervisory experience Highly proficient with Microsoft Office products Valid driver's license and/or dependable transportation necessary Strong written and verbal communication skills; strong analytical, organizational and time management skills Must be able to travel to various offices in the local market regularly This role is considered to be in a patient facing environment and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$69,800 - $96,200 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About Us

About CenterWell Senior Primary Care: CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes. We go beyond physical health by also addressing other factors that can impact a patient's well-being.About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options https://www.partnersinprimarycare.com/accessibility-resources