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.
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
+ 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
+ Three shifts are available for this role: 8 am - 6:30 p.m. EST - Sun, Mon, Tues & Sat / 9 am - 7:30pm EST - Sun, Mon, Tues & Sat / 10 am - 8:30 pm EST - Sun, Mon, Tues & Sat
+ 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
+ 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
Scheduled Weekly Hours
Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms -when and where they need it. Our employees are at the heart of making this happen and that's why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.
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