Weekend UM Admin Coordinator - Fri, Sat, Sun, Mon - SE Region Job at Humana
Responsibilities
Where you Come In
The UM Administration Coordinator 2 provides non-clinical support for the policies and procedures ensuring best and most appropriate treatment, care or services for members. Decisions are typically focus on interpretation of area/department policy and methods for completing assignments. Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction. Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.
Duties include:
- Triage internal and external phone calls appropriately.
- Communicate with providers to request clinical information and coordinate case dispute reviews.
- Review and attach clinical information to authorizations.
- Generate, proof, and send letters to members.
Required Qualifications - What it takes to Succeed
- 1+ years administrative or customer service experience
- Excellent verbal and written communication skills
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences
- Advanced knowledge of MS Office including Word, Excel, and Outlook in a Windows based environment and an ability to quickly learn new systems
- Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); recommended speed is 10Mx1M
- Proven experience working with tight deadlines/timeframe in an ever changing environment
Preferred Qualifications
- Proficient utilizing electronic medical record and documentation programs
- Proficient and/or experience with medical terminology and/or ICD-10 codes
- Prior member service or customer service telephone experience desired
- Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization
Additional Information
How we Value You
- Benefits starting day 1 of employment
- Competitive 401k match
- Generous Paid Time Off accrual
- Tuition Reimbursement
- Parent Leave
- Go365 perks for well-being
Work at Home Requirements
To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
- At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
- Satellite, cellular and microwave connection can be used only if approved by leadership
- Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
- Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Additional Information
This position is supporting Utilization Management in the Southeast Region Health Service Operations/Medicare. It is working Friday, Saturday, Sunday and Monday 10 hour shifts 7am-6pm EST
Scheduled Weekly Hours
40Not Specified
0
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