Humana

About Humana

 

Job Category:

Member Quality & Financials - Utilization Management

Country:

United States

Postal Code:

23058

Approximate Salary:

Not Specified

Position Type:

Full time

Clerical Healthcare Specialist - VA/NC/MD

Humana - Glen Allen

Posted: 07/4/2018

Description

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

Responsibilities

There is in office training in Glenn Allen, VA, Mon-Fri 8am-5pm, the first week of training. 

The Healthcare Specialist 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.

               

Required Qualifications

  • High School Diploma 
  • Minimum 1 year administrative or technical support experience 
  • Excellent verbal and written communication skills
  • Working knowledge of MS Office including Word, Excel, and Outlook in a Windows based environmentand 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

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

Scheduled Weekly Hours

40

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