Role: Healthcare Finder
Assignment:Humana Government Business- Clinical Guidance
*Location: *Work at Home
We’re looking for associates who are dedicated to service and believe in following the Golden Rule of treating others the way you want to be treated. Humana was founded on this premise, and this value is reflected in our expectations for providing perfect service to our consumers, providers, employers, agents and others we work with. At Humana, Perfect Service® means getting the basics done right, delivering value and quality, and providing everyone with personalized attention and guidance. We want to engage with our members through every step of their journey to lifelong well-being. This includes meaningful direct consumer interaction and developing positive relationships with healthcare providers. Humana associates provide Perfect Service every day to our members, employers, providers, and colleagues. We’re looking for people who improve their own well-being by looking out for the best interests of others.
The Clinical Guidance Healthcare Finder for Humana Government Business will assist in ensuring TRICARE beneficiaries receive the highest quality specialty health care through management of the referral/authorization process. Meet TRICARE guidelines of complexity requests of authorizations, 90% within one working day of receipt, on all required information. Identify and direct beneficiaries to the most appropriate, cost-effective medical care, according to HMHS standards of excellence.
Our Department of Defense Contract requires U.S. citizenship for this position. * Triages all incoming referrals/authorizations in order of priority for processing. Enters information into MSR computer and other required/applicable systems.
Coordinates authorizations with PCCs and/or Case Managers according to established HMHS contract standards and guidelines to include timely data entry.
Under direct supervision of RN, directs beneficiaries to high quality, cost effective network providers, monitors outstanding pended authorization referrals for timely completion, verifies DEERS eligibility and Prime enrollment as needed prior to preauthorization or referral.
Communicates effectively with all disciplines of the medical and beneficiary community
Role Essentials * High school diploma or GED.
3 years’ experience in public contact position.
Ability to handle of calls and customer contacts in a polite and professional manner.
Above average written and verbal skills including organizational abilities.
Computer experience including data entry.
Strong attention to detail Role Desirables
UM/Coding experience and/or medical terminology.
Military health care service experience or working knowledge of TRICARE entitlement program.
Associate or Bachelor’s Degree.
Two years prior healthcare/insurance experience
At Humana, we know your well-being is important to you, and it’s important to us too. That’s why we’re committed to making resources available to you that will enable you to become happier, healthier, and more productive in all areas of your life. If you share our passion for helping people, we likely have the right place for you at Humana.
Title: Health Care Finder
Location: Texas-San Antonio
Requisition ID: 172716