Humana

About Humana

 

Job Category:

Member Quality & Financials - Utilization Management

Country:

United States

Postal Code:

40201

Approximate Salary:

Not Specified

Position Type:

Full Time

UM Administration Coordinator 2

Humana - Louisville, Kentucky

Posted: 09/4/2018

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

Location: in office in the following locations San Antonio, TX; Green Bay, WI; Metairie, LA; Louisville, KY in office – Core Hours 7 a.m. – 7 p.m. CST Monday - Friday

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 on a daily basis, answering about 30-50 calls per day where you will assist providers with determining the service they will be providing to a member requires authorization or referral; the provider may be calling in to get status of an authorization; the provider may be calling in to provide clinical information for a pended 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 core hours for this role are between 7 a.m. – 7 p.m. CST Monday – Friday – the specific schedule will be given once in training.   

               

Required Qualifications

  • High School Diploma 
  • 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
  • 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
  • Must be able to work the cores hours which are between 7:00 a.m. – 7 p.m. CST Monday- Friday.

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

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. If you’re ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.

Scheduled Weekly Hours

40

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