Humana UM Administration Coordinator 2 in Aberdeen, South Dakota
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 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 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 where you will assist providers with determining the service they will be providing to a member requires authorization or referral; the provider may be calling in to get status of an authorization; the provider may be calling in to 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. In this role you will:
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
High School Diploma
Excellent verbal and written communication skills
Ability to multitask within several computer systems while on the phone
Aptitude for quickly learning and navigating new technology systems and applications
Must be able to type while taking calls
Proficiency in Microsoft Office applications, including Word and Excel
Operation hours: Staffed 24 hours a day / 7 days a week. Shift bids every 6 months - shifts are determined based on performance.
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
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
Scheduled Weekly Hours
Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.
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