Humana

About Humana

 

Job Category:

Member Quality & Financials - Utilization Management

Country:

United States

Approximate Salary:

Not Specified

Position Type:

Full time

Compliance UM Coordinator

Humana - Work At Home, Colorado

Posted: 08/3/2018

Description

The Compliance (UM) Coordinator 2 conducts and summarizes compliance audits. The Compliance (UM) Coordinator 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.

Responsibilities

The Compliance (UM) Coordinator 2 collects and analyzes data daily, weekly, monthly or as needed to assess outcome and operational metrics for the team and individuals. Collects and analyzes data daily, weekly, monthly or as needed to assess outcome and operational metrics for the team and individuals. Ensures mandatory reporting completed. 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.

Responsibilities include:
  • Make outbound calls to engage members and/or providers to verify clinical information
  • Document all calls and attach clinical information received
  • Create and send out written correspondence

               

Required Qualifications

  • High School Diploma or equivalent
  • Less than 3 years of technical experience
  • Proficiency in Microsoft Office applications, including Word, Excel and Outlook 
  • Excellent verbal and written communication skills

Preferred Qualifications

  • Associate's or Bachelor's Degree in Business, Finance or a related field
  • Clerical support background in a healthcare environment
  • Familiarity with medical terminology and/or ICD-10 codes
  • Experience working in a call center environment a plus
  • CNA or Medical Assistant background a plus

Additional Information

Scheduled Weekly Hours

40

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