Humana

UM Administration Coordinator 2

Kentucky, United States

Not SpecifiedCompensation
Mid-level (3 to 4 years)Experience Level
Full TimeJob Type
UnknownVisa
Healthcare, Government ContractingIndustries

UM Administration Coordinator 2

Employment Type: Full-time

Location Type: Hybrid (requires commutable distance to 101 E. Main Street, Louisville, KY)

Position Overview

Join Humana Government Business, a top 10 Department of Defense contractor with a long history in the TRICARE business. We are seeking a dedicated UM Administration Coordinator 2 to support our Second Level Review team. This role is crucial in ensuring time standards and proper determinations are made to best serve TRICARE providers and beneficiaries. If you enjoy problem-solving, providing innovative solutions, and supporting our nation's military health program, this is the opportunity for you.

Responsibilities

  • Perform clerical fulfillment for medical management team(s).
  • Review, scan, and reroute in-office physical mail related to appeals and denial correspondence.
  • Review and distribute returned mail for research.
  • Identify denial correspondence to be directed to other departments when applicable.
  • Process emails and faxes related to appeals and correspondence.
  • Send out non-covered benefit letters.
  • Enter appropriate information into the Medical Service Review (MSR) system and other required applicable systems.
  • Compose Non-Covered Benefit / Correspondence Letters and send them for mailing.
  • Respond to Defense Health Agency (DHA) & TRICARE Quality Monitoring Contract (TQMC) requests for documentation.
  • Work within defined parameters to identify work expectations and quality standards, with some latitude over prioritization and timing.
  • Follow standard policies and practices that allow for interpretation and independent discretion.

Required Qualifications

  • U.S. Citizenship is required due to Department of Defense contract.
  • Must successfully receive interim approval for government security clearance (NBIS - National Background Investigation Services).
  • Must live within a commutable distance to the Clocktower Building, at 101 E. Main Street, Louisville KY.
  • 1 or more years of administrative and technical support experience.
  • Strong attention to detail.
  • Capacity to maintain confidentiality and work independently.
  • Must be flexible, friendly, engaging, proactive, self-directed, versatile, and dependable.
  • Must be able to work well in a group/team environment.
  • Ability to sit or stand in a stationary position for up to 8 hours.
  • Ability to lift up to 30 lbs.
  • Excellent verbal and written communication skills.
  • Proficient and/or experience with medical terminology and/or ICD-10 codes.
  • Working knowledge of MS Office (Word, Excel, Outlook) in a Windows-based environment.
  • Ability to quickly learn new systems.
  • Ability to handle multiple tasks simultaneously and prioritize appropriately.

Preferred Qualifications

  • Prior experience working in a Mailroom setting.
  • Prior experience working in a managed care organization, including TRICARE.
  • Experience with Utilization Review and/or Prior Authorization.
  • Experience in claims processing.
  • Experience with electronic medical records.

About Humana Government Business

Humana Government Business is dedicated to supporting the TRICARE healthcare program for our nation's military. We have a long history in the TRICARE business and are excited about the T-5 East Region, the next generation of military health contracts. We are committed to putting health first and making an impact through our work.

Skills

Clerical Support
Mail Processing
Data Entry
Claim Denial Codes
Appeals Processing
Email Management
Fax Management
Medical Service Review (MSR) System

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters
1961Year Founded
IPOCompany Stage
Social Impact, HealthcareIndustries
10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.
Rising medical costs and tightening Medicare reimbursements may strain financial performance.
Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.
The company emphasizes inclusivity, offering free language interpreter services for accessibility.
Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.
The company is the first insurer to cover TMS therapy for adolescent depression.
Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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