Prior Authorization UM Administration Coordinator

About the Role

Become a part of our caring community and help us put health first. 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.

Responsibilities

• Support the UM Nurses to process discharge orders and arrange a safe facility discharge.
• Work with UM Nurses, Pharmacy, Medical Directors and other Departments.
• 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

• 1 or more years of experience with Utilization Review and/or Prior Authorization
• 1 or more years of Healthcare experience
• Working knowledge of Microsoft Word, Excel, and Outlook.
• Live in CST or EST states

Preferred Qualifications

• Bilingual English/Spanish
• Proficient utilizing documentation programs.
• Experience with the CarePlus Platform.
• Proficient and/or experience with medical terminology and/or ICD-10 codes.
• Member services

Work Schedule & Additional Information

• Employment Type: Full time
• 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

• Internet Service: 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.
• Internet Reimbursement: 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.
• Equipment: Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Work Environment: Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel

• While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.