Humana

About Humana

 

Job Category:

Member Quality & Financials - Utilization Management

Country:

United States

Postal Code:

32114

Approximate Salary:

Not Specified

Position Type:

Full Time

UM Admin Coordinator - Wed-Sun 8 hour shift between 9:30 AM-7:00 PM WAH in Preferred locations in FL (Please review acceptable locations)

Humana - Daytona Beach, Florida

Posted: 09/23/2018

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

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.

               

Required Qualifications

  • High School Diploma
  • Must reside in the state of Florida
  • 1 year Medical Terminology experience in a clinical or medical administrative setting
  • 1 year minimum experience with electronic health records
  • Recent experience, within the last year, with the appeals process and  correspondence 
  • Proficiency in all Microsoft Office applications, including Word and Excel
  • Excellent communication skills, both verbal and written
  • Working knowledge of computers, or a demonstrated technical aptitude and an ability to quickly learn new systems
  • Must have high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is prohibited).  A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required.
  • Separate room designated for office use only which provides privacy during conversation and correspondence.
  • Must meet hours of operation: Wednesday-Sunday and holiday coverage as needed Hours of operation will be an 8 hour shift between 9:30-7:00 PM

Preferred Qualifications

  • Associate’s or Bachelor’s Degree in Business, Finance or a related field
  • CGX Experience
  • Understanding of CMS and or NCQA Compliance Guidelines
  • Familiarity with 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

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn’t missed) inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
 
Humana is an organization with careers that change lives—including yours.  As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. 

Scheduled Weekly Hours

40

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