UM Administration Coordinator 2-Remote US

Profile

Description

The UM Administration Coordinator 2 contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.

Responsibilities

Location: Work at home anywhere; Shift runs between 7 a.m. - 7 p.m. CST Monday - Friday 8 hour shifts

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.

As a UM Coordinator you will be part of our fast paced Clinical Call Center where you will engage with providers and/or members on a daily basis, answering about 30-50 calls per day where you will assist providers and/or members with authorization and/or referral requirements.

The provider and/or member may be calling in to get status of an authorization; build or update an authorization. As a UM coordinator you will be collecting clinical information and reviewing resources and data to determine positive outcomes for our consumers. This position requires the use of multiple systems, therefore the ability to maneuver multiple systems at one time is vital. In this role you will:

Take inbound calls to engage members and/or providers to verify clinical information

Handle customer inquiries both telephonically and by fax

Document all call information according to standard operating procedures and attach clinical information when necessary

Identify and escalate issues

The shift for this role runs between 7 a.m. - 7 p.m. CST Monday - Friday 8 hour shifts (including weekends and potential holidays)

Required Qualifications

Prior experience with CGX, Softphone, Service Read Only

Prior authorization list experience

UM authorization and referral process knowledge

Market guide knowledge required

Excellent verbal and written communication skills

Ability to multitask within several computer systems while on the phone

Aptitude for quickly learning and navigating new technology systems and applications

Must be able to type while taking calls

Proficiency in Microsoft Office applications, including Word and Excel

Must have a private office to protect confidential information

Work-At-Home Requirements

WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.

A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.

Satellite and Wireless Internet service is NOT allowed for this role.

A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Preferred Qualifications

Proficient utilizing electronic medical record and documentation programs

Proficient and/or experience with medical terminology and/or ICD-10 codes

Bachelor's Degree in Business, Finance or a related field

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

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana's secure website.

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com