Humana Referral Coordinator in North Palm Beach, Florida

Role Title: Referral Coordinator

Assignment: MetCare of Florida

Location: North Palm Beach, FL

Role Description:

As a Referral Coordinator, you will contribute to Humana’s integrated care delivery strategy by assisting in the coordination of specialty and ancillary care for our patients in a timely and professional manner.

In this role, individuals will perform the following functions:

  • Process referrals from primary care providers for specialty and ancillary care in a timely manner, prioritizing the referrals according to defined levels of urgency, scheduling member appointments as necessary and communicating referral information to patients.

  • Collect information concerning patient's clinical background and referral needs. Per referral guidelines, provide appropriate clinical information to reviewing clinicians and specialists. Present necessary medical information such as history, diagnosis and prognosis.

  • Remind patients of scheduled appointments via mail or phone.

  • Assist patients in problem solving potential issues related to the health care system, financial or social barriers (e.g., request interpreters as appropriate, transportation services or prescription assistance). Identify and utilize cultural and community resources.

  • Establish and maintain relationships with identified service providers.

  • Maintain ongoing tracking and appropriate documentation on referrals to promote team awareness and ensure patient safety and access to care.

  • Contact review organizations and insurance companies to ensure prior approval requirements are met.

  • Ensure consultation reports are received from the consulting provider to maintain continuity of care.

  • Partners with Network Development to ensure specialist network is adequate for the geography and escalates accordingly when network adequacy impacts access to care.

  • Demonstrate respect for the privacy and confidentiality of patient’s protected health information

  • Other duties as assigned.

    Role Essentials

  • High School Diploma or GED

  • Proficient with medical terminology

  • 1 year or more of hands-on healthcare experience in a clinical setting, preferably within the Medicare population

  • Proficient with Microsoft Office applications including Microsoft Word, Excel and Outlook

  • Experience with Electronic Medical Records

  • Excellent professional communication abilities, at all levels within the organization and with patients, at all times

  • This role is considered patient facing and is part of the company’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB

  • If selected for this role, you will be required to complete and pass background check/investigation for AHCA compliance

    Role Desirables:

  • Bachelor’s Degree in Healthcare or Business Administration

  • Bilingual in English and Spanish is a plus

  • Knowledge of ICD 10 and CPT coding

  • Referral experience

  • Medical Assistant or Professional State Certifications related to healthcare

    Interview Format:

    As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule.

    If you are selected for a first round interview, you will receive an email correspondence inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Title: Referral Coordinator

Location: FL-North Palm Beach

Requisition ID: 178275