Compliance (UM) Coordinator

Humana • Work at Home - Kentucky, SC

2d • $43,000 - $56,200 • Remote

About The Position

The Compliance (UM) Coordinator issues notice of adverse benefit determination letters for Medicaid line of business to ensure adherence to contractual and accreditation requirements. This role generates notice of adverse benefit determination and approval letters for Medicaid Utilization Management (UM) authorization determinations in compliance with accreditation entities requirements, state contractual requirements, and organizational policies and procedures. This role works independently while meeting and maintaining the role required production and quality metrics. It collaborates with teammates to ensure overall team success and compliance. The role analyzes report data daily, weekly, monthly, and as needed to assess and identify trends that pose a compliance risk to UM authorization determinations.

Requirements

• 1+ year of experience in healthcare or related field
• 1+ year of data entry experience
• Proficiency in Microsoft Office applications, including Word, Excel and Outlook
• Self-provided internet service must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Nice To Haves

• Knowledge of Medicaid Utilization Management
• Clerical support background in a healthcare environment
• Familiarity with medical terminology and/or IC-10 codes
• CNA or Medical Assistant background a plus

Responsibilities

• Generates notice of adverse benefit determination and approval letters for Medicaid Utilization Management (UM) authorization determinations in compliance with accreditation entities requirements, state contractual requirements, and organizational policies and procedures
• Works independently while meeting and maintaining the role required production and quality metrics
• Collaborates with teammates to ensure overall team success and compliance
• Analyzes report data daily, weekly, monthly, and as needed to assess and identify trends that pose a compliance risk to UM authorization determinations

Benefits

• medical
• dental
• vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed