[Remote] UM Coordinator 2 at Humana

San Antonio, Texas, United States

Apply Now

Not SpecifiedCompensation

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

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Minimum 1 year of customer service experience, including the ability to effectively de-escalate challenging situations
After training, available to work any shift between 6am-7pm CST, including occasional weekends based on business needs
Excellent verbal and written communication skills
Demonstrated attention to detail
Ability to navigate process flows and follow procedure documents
Proficient keyboarding skills for data entry and documentation
Capacity to multitask across various computer systems while engaging with providers or members
Quick aptitude for learning and navigating new technology systems and applications
Proficiency in Microsoft Office applications, including Word and Excel
A designated workspace with a closed door that minimizes distractions and meets leadership approval
Must effectively manage personal responsibilities to ensure a professional work environment conducive to achieving performance goals
Preferred Qualifications
Proficient utilizing electronic medical record and documentation programs
Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization
Knowledge of Medical Terminology and/or ICD-10 codes
Bilingual (English & Spanish) fluent in written and verbal communication

Responsibilities

Taking inbound calls and assisting providers in determining whether a specific service for a member requires prior authorization or referral, ensuring compliance with established guidelines and processes
Initiate the authorization process by collecting clinical information and verifying medical necessity, ensuring members are not subjected to unnecessary services or expenses
Respond to provider inquiries regarding existing authorizations or referrals, and provide timely updates as needed through fax or inbound phone line, ensuring compliance with organizational policies and applicable federal regulations
Document all call information according to standard operating procedures and attach clinical information when necessary
Support members with authorization requests, including outbound calls to provider offices when required
Review resources and data to facilitate positive outcomes for consumers, adapting to ongoing changes in processes and procedures due to CMS regulations
Maintain high-quality standards and meet monthly quality requirements
Ability in maneuvering multiple systems simultaneously
Communicate ideas and updates clearly to team members, actively listen to feedback and concerns, and facilitate open, honest dialogue
Collaborate and contribute effectively to team projects and goals, supporting colleagues and resolving issues that impact the team
Share knowledge, work effectively with cross-functional teams, and coordinate tasks and responsibilities among team members
Identify and address potential conflicts within the team, facilitating constructive discussions to resolve disagreements

Skills

Key technologies and capabilities for this role

Utilization ManagementPrior AuthorizationMedical Necessity VerificationProvider CommunicationClinical DocumentationCMS RegulationsCustomer ServiceInbound CallsOutbound CallsData EntryMulti-System Navigation

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.

Land your dream remote job 3x faster with AI

Try Jobo Free