Humana Looking For UM Administration Coordinator 2 – WAH – Florida region – (Wed – Sunday 9am-6pm EST)) at Tampa, FL Full Time

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 provides non-clinical support for the policies and procedures ensuring best and most appropriate treatment, care or services for members. Decisions are typically focus on interpretation of area/department policy and methods for completing assignments. Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction. Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.

Triage internal and external phone calls appropriately.

Communicate with providers to request clinical information and coordinate case dispute reviews.

Review and attach clinical information to authorizations.

Generate, proof, and send letters to members.

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

** Wednesday thru Sunday 9am-6pm EST; 40 hrs per week

Scheduled Weekly Hours

40