[Remote] UM Administration Coordinator at Humana

San Antonio, Texas, United States

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Not SpecifiedCompensation

Entry Level & New Grad, Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

Health Insurance, HealthcareIndustries

Requirements

Candidates must have prior customer service and/or call center experience, proficiency in Microsoft Office applications (Word, Excel), excellent verbal and written communication skills, and the ability to multitask within several computer systems while on the phone. A strong aptitude for quickly learning and navigating new technology systems and applications, along with good typing skills, is also required. Preferred qualifications include proficiency with electronic medical record and documentation programs, experience with medical terminology and/or ICD-10 codes, and prior experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization.

Responsibilities

The UM Administration Coordinator will engage with members and providers daily, managing approximately 30 to 50 calls to assist providers in determining prior authorization or referral needs and respond to inquiries about authorization statuses. Responsibilities include gathering clinical information for pending authorizations, supporting members with authorization requests, and making outbound calls to provider offices. The role involves collecting and reviewing clinical data, maneuvering multiple computer systems simultaneously, documenting call information according to standard operating procedures, attaching clinical information when necessary, and identifying and escalating issues.

Skills

Prior Authorization

Referral Management

Clinical Data Review

Customer Service

Call Center Operations

Multi-system Navigation

CMS Regulations

Documentation

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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