[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

1 or more years’ experience working in an administrative support capacity in a healthcare setting
Excellent verbal and written communication skills
Demonstrated attention to detail
Ability to navigate process flows and follow procedure documents
Working knowledge of MS Office including Word, Excel, Teams, and Outlook in a Windows based environment
Ability to quickly learn new systems
Proficient in electronic medical record and documentation programs (preferred)
Prior experience with CGX and Genesys (preferred)
Prior experience with post-acute authorizations (preferred)
Prior experience in a metric driven environment (preferred)
Prior experience in the healthcare industry (preferred)
Proficient and/or experience with medical terminology and/or ICD-10 codes (preferred)
Prior member service or customer service telephone experience (desired)

Responsibilities

Intercepting inbound calls and assisting facilities/providers in scheduling and coordinating Peer to Peer discussions
Managing Humana Medical Directors' calendars
Monitoring and decisioning authorizations
Responding to provider inquiries regarding existing authorizations, and providing timely updates as needed via fax or phone calls, ensuring compliance with organizational policies and applicable federal regulations
Maintaining high-quality standards and meeting monthly quality requirements
Maneuvering multiple systems simultaneously
Communicating ideas and updates clearly to team members, actively listening to feedback and concerns, and facilitating open, honest dialogue
Collaborating and contributing effectively to team projects and goals, supporting colleagues and resolving issues that impact the team
Sharing knowledge, working effectively with cross-functional teams, and coordinating tasks and responsibilities among team members

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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