Bilingual Telephonic UM Coordinator

Employment Type

Full time

About the Role

Become a part of our caring community and help us put health first. The Bilingual Telephonic UM Coordinator / UM Administration Coordinator 2 provides non-clinical support for the policies and procedures ensuring best and most appropriate treatment, care or services for members.

Bilingual Telephonic UM Coordinator Responsibilities

• Primarily receive calls from Providers, Hospitals, Skilled Nursing Facilities and other vendors
• Support the UM Nurses to process discharge orders and arrange a safe facility discharge
• Work with UM Nurses, Pharmacy, Medical Directors and other Departments
• During downtime make calls to UM Nurses, Hospitals, Skilled Nursing Facilities and other vendors
• Document all calls and requests
• Search for Medicare and Medicaid Guidelines
• Process all incoming fax/emails request for services the same day
• Return call for all voice messages received the same day
• Process provider and member letters (Letter of Agreements, Approvals, Denials etc.)
• Mail letters to members
• Assist the team with various clerical/administrative tasks as necessary
• Participate in special projects as assigned by your Supervisor or Manager
• Use your skills to make an impact

Required Qualifications

• Bilingual English/ Spanish: Must be able to speak, read and write in both languages without limitations or assistance. See Additional Information on testing.
• 1 or more years of Administrative support experience
• 1 or more years of Healthcare experience
• 1 or more years of telephonic Customer Service experience
• Working knowledge of Microsoft Word, Excel, and Outlook.
• Work Schedule: Monday-Friday 8am-5pm EST, must have ability to work Nights, Weekends and Holidays 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
• Member service experience
• Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization

Additional Information

Language Proficiency Testing

Any Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government.

Work Schedule

Monday-Friday 8am-5pm EST, and work 1 weekend a quarter. Schedule subject to change based on business needs.

Interview Process

As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, 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 Sou