UM Administration Coordinator - Clinical Claims Review

Company: Humana
Location: Tulsa
Posted on: November 17, 2023

Job Description:

DescriptionThe UM Administration Coordinator 2 contributes to administration of utilization management. The UM Administration Coordinator 2 performs basic administrative, clerical, operational, customer support, and computational tasks working on semi-routine and patterned assignments.ResponsibilitiesThe UM Administration Coordinator 2 provides non-clinical support, following established policies and procedures ensuring best and most appropriate treatment, care, or services for members. -Prepares and forwards authorization request to clinical reviewWorks within defined parameters to identify work expectations and quality standards, but has some autonomy over prioritization/timing, and works under minimal direction.Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
Key Responsibilities:

• Completes inbound and outbound provider calls to answer UM related questions and prepare authorization request for clinical review
• Document calls and attach clinical information to the member's medical record
• Create and send out written correspondence
• Ability to multitask and prioritize
• Collaborate with multiple -roles/departments/providers/team -membersRequired Qualifications
  • Minimum 1 year of healthcare or clinical experience (working for a health plan, organization, or provider)
  • 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 and ability to troubleshoot and resolve basic technical difficulties in a remote environment.
    Workstyle: Remote work at homeLocation: -OklahomaSchedule:
    • Must be able to work a 40-hour work week, Monday through Friday, 8:00 AM to 5:00 PM Central Time
    • Over-time and weekends may be requested to meet business needs.
    • Leader will discuss during interview.Travel: Minimal travel for office meetings 1-2 times annually
      Work at Home Guidance To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
      • At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
      • Satellite, cellular and microwave connection can be used only if approved by leadership
      • Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
      • Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
      • Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
        Preferred Qualifications
        • Proficient utilizing electronic medical record and documentation programs
        • Prior member service or customer service telephone experience desired
        • Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization
        • Clerical support background in a healthcare environment
        • Familiarity with medical terminology and/or ICD-10 codes
        • CNA or Medical Assistant background a plus
          Additional Information
          Interview Format
          As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Modern Hire Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
          If you are selected for a first-round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn't missed) inviting you to participate in a Modern Hire Voice interview. In this interview, you will listen to a set of interview questions over your phone, and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.
          If you have additional questions regarding this role posting, please send them to the Ask A Recruiter persona by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.
          SSN AlertHumana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana's secure website.
          Benefits
          Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security-both today and in the future, including:Health benefits effective day 1; Paid time off, holidays, volunteer time and jury duty pay; Recognition pay; 401(k) retirement savings plan with employer matchTuition assistance; Scholarships for eligible dependents; Parental and caregiver leave; Employee charity matching program; Network Resource Groups (NRGs)Career development opportunities!
          #L1-RemoteScheduled Weekly Hours40

Keywords: Humana, Tulsa , UM Administration Coordinator - Clinical Claims Review, Healthcare , Tulsa, Oklahoma