Process incoming medical referrals, enter accurate data into medical management systems, and assign appropriate healthcare providers.
Review referrals for benefits and medical necessity, escalate sensitive cases for clinical assessment, and apply ICD-10 and CPT codes.
Communicate with military treatment facilities and civilian providers, respond to inquiries, and manage referral tasks within established timelines.
This position is listed on behalf of a partner company that manages all applications and next steps. The company supports healthcare service delivery by ensuring medical referrals are processed accurately and efficiently within a structured, collaborative remote team.
Create the blueprint for configuration of medical and dental plans from plan documents and standards.
Build, validate and test plan benefits and code mapping logic for accurate claims processing.
Troubleshoot system issues and coordinate with teams to improve efficiency and resolution.
Centivo is an innovative health plan for self-funded employers on a mission to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. Backed by leading healthcare and technology investors, the company is headquartered in Buffalo, NY and values resilience, uncommon thinking, and positivity.
Independently audit professional-fee coding for accuracy, compliance, and reimbursement impact.
Evaluate ICD-10-CM, CPT, HCPCS Level II, E/M services, modifiers, and professional components.
Prepare reports, deliver coding education, and maintain 95% audit accuracy.
A large regional healthcare network providing medical services across multiple facilities. The culture emphasizes independent auditing, high accuracy, and collaborative compliance education.