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.