Referrals Coordinator

Work arrangement: Remote
Location: US
Compensation: Not disclosed
Apply by: April 13, 2027

About this role

<h3>Accountabilities</h3><li>
Referral Processing and Data Entry:Process incoming medical referrals, enter accurate information into medical management systems, and assign appropriate healthcare providers based on established procedures and referral requirements.</li><li>
Benefits and Medical Necessity Review:Review referrals for applicable healthcare benefits and medical necessity requirements, identifying cases that need further clinical assessment or additional documentation.</li><li>
Referral Escalation and Coordination:Identify sensitive diagnoses and referrals that may require case management, and forward them to the appropriate nurse, supervisor, or case management contact for review and follow-up.</li><li>
Medical Coding and Documentation:Assign appropriate ICD-10 diagnosis codes and CPT procedure codes to referrals, ensuring accurate classification and complete documentation.</li><li>
Healthcare Provider Communication:Respond to referral-related inquiries, handle incoming calls, and contact military treatment facilities (MTFs) and civilian healthcare providers to obtain missing information or clarify referral details.</li><li>
Policy and Process Compliance:Apply relevant healthcare referral procedures, utilization management policies, memoranda of understanding with military treatment facilities, and applicable benefits and coverage guidelines.</li><li>
TRICARE Referral Support:Apply knowledge of TRICARE benefits and limitations to help ensure referrals are processed according to established military healthcare requirements.</li><li>
Administrative Accuracy and Efficiency:Maintain organized records, manage multiple requests, and ensure referral tasks are processed within established timelines and quality standards.</li><li>
Customer Service:Provide clear, professional assistance to individuals and healthcare partners, addressing questions and facilitating the resolution of referral-related issues.</li><h2>Requirements</h2><li>
Citizenship and Security Clearance:U.S. citizenship is required due to government contract requirements. Candidates must successfully obtain interim approval for a government security clearance through the National Background Investigation Services (NBIS) process.</li><li>
Professional Experience:At least 2 years of customer service experience and/or administrative or data entry experience.</li><li>
Healthcare Experience:At least 2 years of healthcare experience, with an intermediate working knowledge of medical terminology, CPT codes, and ICD diagnosis coding.</li><li>
Technical Proficiency:Strong proficiency in Microsoft Office applications, including Outlook, Word, PowerPoint, and Excel, with the ability to navigate multiple computer systems and applications efficiently.</li><li>
Medical Referral Knowledge:Understanding of referral processing, healthcare benefits, medical necessity requirements, and medical documentation practices.</li><li>
Attention to Detail:Strong organizational skills and the ability to maintain accurate records, assign appropriate codes, and handle sensitive medical information responsibly.</li><li>
Communication Skills:Clear written and verbal communication skills, with the ability to interact professionally with healthcare providers, internal clinical teams, and other stakeholders.</li><li>
Problem-Solving and Prioritization:Ability to recognize complex or sensitive cases, determine when additional review is necessary, and manage multiple tasks accurately within established deadlines.</li><li>
Schedule Availability:Ability to work an 8-hour shift scheduled between 8:00 a.m. and 5:00 p.m. Eastern Time, with potential overtime depending on business needs.</li><li>
Remote Work Requirements:A dedicated home workspace that protects confidential health information and supports compliance with HIPAA privacy requirements. Home internet service must provide a minimum download speed of 25 Mbps and upload speed of 10 Mbps; a wireless, wired cable, or DSL connection is suggested.</li><li>
Preferred Qualifications:Veteran or military spouse status, experience with TRICARE, familiarity with military treatment facility agreements and referral procedures, experience in a managed care environment, and advanced knowledge of medical terminology and ICD-10 coding.</li><li>
Location Restrictions:Applicants must reside in the United States and cannot currently reside in Puerto Rico due to government contract restrictions.</li><h2>Benefits</h2><li>
Competitive Compensation:Annual base salary ranging from$39,000 to $49,400, depending on location, qualifications, relevant experience, education, and job-related skills.</li><li>
Performance Incentives:Eligibility for a bonus incentive plan based on company and/or individual performance.</li><li>
Healthcare Coverage:Medical, dental, and vision insurance options to support employees and their families.</li><li>
Retirement Savings:Access to a 401(k) retirement savings plan.</li><li>
Paid Time Off:Paid time off, company holidays, and personal holidays.</li><li>
Family Support:Paid parental leave and caregiver leave.</li><li>
Financial Protection:Short-term and long-term disability coverage and life insurance.</li><li>
Remote Work Flexibility:Nationwide remote work arrangements, subject to residency and contractual requirements.</li><li>
Employee Well-Being:Benefits and programs designed to support personal wellness, healthcare needs, and work-life balance.</li><li>
Professional Development:Opportunities to develop healthcare administration, medical referral coordination, and managed care expertise.</li><li>
Additional Benefits:Access to other employee programs and resources, subject to eligibility.</li><li>
Travel:Occasional travel to company offices may be required for training or meetings.</li>