Select your country: United States Canada Deutschland

UM Administration Coodinator 2 - Birmingham, AL #6267623


Company: Humana

Date: 04/02/2019

Category: Restaurant / Food Services

City: Birmingham, AL

Description


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.


Responsibilities


The UM Administration Coordinator 2 on the Adverse Determination team will schedule peer to peer reviews, distribute the results of the peer review upon completion to the provider and complete adverse determination letters. This is a non-clinical support role. In this role you will:


  • Scheduling consists of:

Auditing the case, contacting the clinical advisor if there are any corrections and ensuring that the information is accurately transmitted to our Vendor.


  • Distribution consists of:

Auditing case information returned from the vendor for accuracy, calling the facility with the results of the case and documenting in CGX the contact and outcome.


  • Letter writing consists of:

Verifying information in the review is accurate, using established denial templates to create the adverse letter, sending for audit and mailing our through Veritas.


  • Additional team responsibilities include checking team voicemail, creating denial packets and QIO appeal requests.

Role Essentials


  • High School Diploma


  • Minimum 1 year administrative or technical support experience


  • Excellent verbal and written communication skills


  • Basic knowledge of MS Office including Word, Excel, and Outlook


  • Ability to quickly learn new systems


  • Detail oriented


  • Strong communication skills both written or verbal


  • 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)

Role Desirables


  • Basic knowledge of behavioral health


  • Proficient and/or experience with medical terminology and/or ICD-10 codes


  • Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization

Additional Information


Humana is an organization with careers that change lives—including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you’re ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.


Scheduled Weekly Hours


40


About Us


Equal Opportunity Employer


It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster.


If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact mailbox_tas_recruit@humana.com for assistance.


Humana Safety and Security


Humana will never ask, nor require a candidate provide money for work equipment and network access during the application process. If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact mailbox_tas_recruit@humana.com to validate the request.




Select your country: United States Canada Deutschland