[Remote] UM Administration Coordinator at Humana

San Antonio, Texas, United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

Minimum of one (1) year of administrative experience working in a healthcare setting
Ability to work EST hours, Monday – Friday; 8:00am – 5:00pm Eastern Standard Time (EST)
Excellent verbal and written communication skills
Working knowledge of MS Office including Word, Excel, and Outlook in a Windows based environment
Proficient utilizing electronic medical record and documentation programs
Proficient and/or experience with medical terminology and/or ICD-10 codes
Bachelor’s degree in business, finance or a health-related field
Prior member service or customer service telephone experience desired
Experience with LTSS Utilization Review and/or Prior Authorization, preferably within a managed care organization
Additional Qualifications:
Proficient electronic medical record and documentation programs

Responsibilities

Provide non-clinical support for policies and procedures ensuring best and most appropriate treatment, care or services for members
Interpret and apply area/department policy and methods for completing assignments
Identify work expectations and quality standards
Prioritize and manage time effectively
Manage shared mailboxes and enter data into work queues and/or clinical documentation systems
Mailing letters/educational material, preparing documents to LTSS UM reviewers and Medical Directors
Ensure timely and correct submission of state-required deliverables
Interact with care coordinators and other internal and external stakeholders
Perform varied activities including reporting data, tracking data, pulling reports and monitoring/managing email
Make, receive, and soft transfer calls to and from members, providers, family, etc
Ensure timely communication and follow up occurs with care management
Use skills to make an impact

Skills

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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