Compliance UMAC 3 (M-F)

Humana

3d • $44,900 - $60,200 • Remote

About The Position

The Compliance (UM) Coordinator 3 reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations. The Compliance (UM) Coordinator 3 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. This role will follow a four-day, 10-hour shift schedule during the standard Monday through Friday work week. The schedule will be either Monday through Thursday or Tuesday through Friday, with work hours scheduled between 8:00 a.m. and 8:00 p.m. Eastern Time. The Compliance (UM) Coordinator 3 collects and analyzes data daily, weekly, monthly, or as needed to assess outcome and operational metrics for the team and individuals. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related workstreams. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Assignments are varied and often complex, requiring independent judgment, critical thinking, and interpretation of guidelines to determine appropriate courses of action. Follows established guidelines, regulatory turnaround times, and procedures for processing QIO fast track appeals and expedited authorization requests.

Requirements

• 1 - 3 years of technical experience
• Proficient in Microsoft Word & Excel
• Strong attention to detail and accuracy
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
• Excellent verbal and written communication skills
• Clerical support background in a healthcare environment
• Ability to work independently in an agile environment under general instructions and within a team.
• Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role).
• A minimum standard speed for optimal performance is 25mbs download x 10mbs upload is required.
• A dedicated office space lacking ongoing interruptions so you can meet productivity requirements, and to protect member PHI / HIPAA information.

Nice To Haves

• UM experience with auditing or compliance
• UM experience with processing expedited requests or QIO appeals
• The ideal candidate for this opening would be a current member of the One Home / Home Solutions UM Team who has been in their current position for 12+ months
• Associates' or Bachelor's degree in Healthcare, Business. Finance, or related field
• Familiarity with medical terminology and/or ICD-10 codes

Responsibilities

• Reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations.
• Collects and analyzes data daily, weekly, monthly, or as needed to assess outcome and operational metrics for the team and individuals.
• Understands department, segment, and organizational strategy and operating objectives, including their linkages to related workstreams.
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.
• Follows established guidelines, regulatory turnaround times, and procedures for processing QIO fast track appeals and expedited authorization requests.

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: Associate degree