UM Administration Coordinator - Clinical Operations

Profile

Description

The UM Administration Coordinator contributes to administration of utilization management. The UM Administration Coordinator performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.

The UM Administration Coordinator is responsible for building authorizations in CGX and faxing to Humana Medical Directors for approval or denial and/or writing approval or denial letters.

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

1 years healthcare administration or managed care experience

Excellent verbal and written communication skills

Ability to demonstrate excellent verbal and written communication skills with members and providers

Working knowledge of MS Office including Word, Excel, and Outlook in a Windows based environment and an ability to quickly learn new systems

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 passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

Proficient utilizing electronic medical record and documentation programs

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

CGX experience

Bachelor's Degree preferred

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

Additional Information

Schedule: Monday-Friday 7am-4pm OR 8am-5pm CST

Location: Work at home nationwide

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com