UM Administration Coordinator

Humana

2d • $40,000 - $52,300 • Remote

About The Position

The UM Administration Coordinator 2 provides non-clinical support for the policies and procedures ensuring best and most appropriate treatment, care or services for members. As a UM Coordinator you will report to the Manager, UM Administration. You will be part of our fast-paced Clinical Call Center where you will engage with Providers on a daily basis, answering about 30-50 calls per day, and assist with determining the services they will be providing to a member requiring authorization or referral. The Provider may be calling in to get status of an authorization; or provide clinical information for a pended authorization. As a UM coordinator you will be collecting clinical information and reviewing resources and data to determine positive outcomes for our consumers. This position requires the use of multiple systems, therefore the ability to maneuver multiple systems at one time is vital.

Requirements

• Experience with Utilization Review and/or Prior Authorization within a managed care call center
• Experience with CGX, Genesys, DIG Toolbar, and SRO UM
• Clinical intake process experience in Medicare, Medicaid, and DSNP
• Demonstrated ability to articulate ideas effectively in both written and oral forms
• Ability to multitask within several computer systems, including Word and Excel, while on the phone
• Aptitude for quickly learning and navigating new technology systems and applications
• Must be able to type while taking calls
• Must have a private office to protect confidential information

Nice To Haves

• Bachelor's Degree in Business, Finance or a related field
• Proficient utilizing electronic medical record and documentation programs
• Proficient and/or experience with medical terminology and/or ICD-10 codes
• Prior member service or customer service telephone experience desired

Responsibilities

• Take inbound calls to engage members and/or providers to verify clinical information
• Handle customer inquiries both telephonically and by fax
• Document all call information according to standard operating procedures and attach clinical information when necessary
• Identify and escalate issues
• Use your skills to make an impact

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