UM Administration Coordinator

UM Administration Coordinator 2:

• Make outbound calls to providers to verify clinical information

• Provides non-clinical support for the policies and procedures ensuring best and most appropriate treatment, care or services for members

• Work member cases from the provider side (doctors, primary care physicians, specialists, etc.)

• Document calls and attach clinical information received

• Approve or send to nurses for medical review

• Process all incoming fax/emails requests for services

• Assist the team with various clerical/administrative tasks as necessary

• Participate in special projects as assigned by your Supervisor or Manager

Required Qualifications

• 1 or more years of Healthcare and/or telephonic Customer Service experience

• Working knowledge of Microsoft Word, Excel, and Outlook

• Work Schedule: Monday - Friday 8am-5pm EST, must have ability to work overtime and one weekend per quarter based on business needs

Preferred Qualifications

• Proficient utilizing documentation programs

• Experience with the CarePlus Platform

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

• Prior member service

• Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization

• Bilingual English/Spanish

Additional Information

Work Schedule:

• Monday - Friday 8am-5pm EST, must have ability to work overtime and one weekend per quarter based on business needs.

Additional Information
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.

Work at Home Guidance

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

• Satellite, cellular and microwave connection can be used only if approved by leadership

• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Internal- If you have additional questions regarding this role posting, please send them to the Ask A Recruiter persona by visiting go/yammer and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.

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

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