UM Administration Coordinator

Humana•3d ago

United StatesRemote$40K–$52.3KFull-timeEntry Level1+ yrs exp

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Become a part of our caring community The UM Administration Coordinator 2 contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments. The role provides nonclinical support for the policies and procedures ensuring the best and most appropriate treatment, care or services for members. Decisions typically focus on interpretation of area/department policy and methods for completing assignments. Humana Healthy Horizons in Indiana is seeking Authorization Team Members to support the Utilization Management (UM) Process by managing authorization requests, coordinating approvals
ensuring compliance with policies and procedures. The UM Administration Coordinator 2 role is critical in supporting the UM team and care coordinators by handling authorization processing, allowing them to focus on direct member support. The Authorization Team Member will work closely with members providers, internal UM staff
care coordinators to ensure efficient and accurate processing of service authorizations. Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing
works under minimal direction. Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion. Responsibilities include (but not limited to):
Accurately and efficiently process and enter authorization requests into the system.
Review care team submitted service requests and validate required documentation before processing.
Coordinate follow-up with the care team for missing or additional required information.
Maintain detailed records of authorization approvals, denials, and modifications.
Collaborate with UM nurses and care teams to escalate requests requiring additional clinical review.
Monitor authorization timelines and turnaround times to prevent delays.
Serve as a liaison between providers, members, and internal teams, ensuring smooth communication regarding service approvals.
Identify potential discrepancies, errors, or inefficiencies and work proactively to resolve them.
Assist with training and onboarding of new team members as needed. Use your skills to make an impact Required Qualifications 1 or more years administrative or technical support experience Excellent verbal and written communication skills Working knowledge of MS Office including Word, Excel, and Outlook in a Windows based environment and an ability to quickly learn new systems Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role)
recommended speed is 10Mx1M Must be passionate about contributing to an organization focused on continuously improving consumer experiences Preferred Qualifications Proficient utilizing electronic medical record and documentation programs Proficient and/or experience with medical terminology and/or ICD-10 codes Bachelor's Degree in Business, Finance or a related field Prior member service or customer service telephone experience desired Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization Additional Information Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $40,000 - $52,300 per year Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About us About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Required skills

MS Officemedical terminologyICD-10