[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

Healthcare, Health InsuranceIndustries

Requirements

1+ years’ experience working in an administrative support capacity
Prior professional experience of Microsoft Word, Outlook and Excel with the ability to type and enter data accurately
Ability to quickly learn new systems (proficient to advanced)
Work-at-home setup with minimum download speed of 25 Mbps and upload speed of 10 Mbps (wireless, wired cable, or DSL recommended; satellite/cellular/microwave only if approved)

Responsibilities

Manages NLP's for chart reviews for the nursing team
Builds and pends authorizations for review
Responsible for inbound and outbound calls to engage providers and members to verify clinical information/discharge date and admission status throughout the day
Documents calls and attaches clinical information received
Requests clinical information from providers/facilities
Creates and sends out written correspondence
Creates and distributes determination letters
Collaborates with multiple roles/departments/providers/team members
Provides non-clinical support for policies and procedures ensuring best and most appropriate treatment, care or services for members utilizing Home Health and Skilled Nursing Facility services

Skills

Key technologies and capabilities for this role

Administrative SupportUtilization ManagementChart ReviewsAuthorizationsInbound CallsOutbound CallsProvider EngagementMember VerificationClinical DocumentationCorrespondenceDetermination LettersCollaboration

Questions & Answers

Common questions about this position

What benefits does Humana offer for this position?

Humana offers industry-leading benefits starting on the first day, including medical, dental, vision benefits, health savings accounts, flex spending accounts, life insurance, 401(k), PTO with 8 paid holidays, one personal holiday, one volunteer day, 23 days annual PTO, parental leave, caregiving leave, and weekly well-being time.

Is this a remote position?

Yes, this is a remote position with the possibility of flexible working hours Monday to Friday between 8am and 8pm EST, requiring 8 paid hours per business day.

What are the required qualifications for the UM Administration Coordinator role?

Required qualifications include 1+ years’ experience in administrative support, prior professional experience with Microsoft Word, Outlook, and Excel with accurate typing and data entry, and the ability to quickly learn new systems at a proficient to advanced level.

What is the salary for this position?

This information is not specified in the job description.

What makes a strong candidate for this UM Administration Coordinator position?

Strong candidates have experience with Utilization Review, Prior Authorization in managed care, electronic medical records, medical terminology or ICD-10 codes, member or customer service calls, SNF or Home Health, CGX, SRO, HCHB, metric-driven environments, and the healthcare industry.

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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