Description
The Compliance (UM) Coordinator 3 reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations.
This role involves collecting and analyzing data daily, weekly, monthly, or as needed to assess outcome and operational metrics for the team and individuals. You will make decisions regarding your own work methods, occasionally in ambiguous situations, and require minimal direction.
Your responsibilities include:
- Reviewing utilization management activities and documentation
- Collecting and analyzing data to assess outcome and operational metrics
- Making decisions regarding own work methods
- Following established guidelines, regulatory turnaround times, and procedures for processing QIO fast track appeals and expedited authorization requests
Requirements:
- 1-3 years of technical experience
- Proficient in Microsoft Word & Excel
- Strong attention to detail and accuracy
- Excellent verbal and written communication skills
- Clerical support background in a healthcare environment
- Ability to work independently in an agile environment under general instructions and within a team
Preferred qualifications:
- UM experience with auditing or compliance
- UM experience with processing expedited requests or QIO appeals
- Associates' or Bachelor's degree in Healthcare, Business, Finance, or related field
- Familiarity with medical terminology and/or ICD-10 codes
Additional information:
- This position is remote nationwide
- The role follows a four-day, 10-hour shift schedule within a Wednesday through Sunday work week
- The assigned schedule will be either Wednesday through Saturday or Thursday through Sunday, with work hours scheduled between 8:00 a.m. and 8:00 p.m. Eastern Time
- Occasional travel to Humana's offices for training or meetings may be required
Benefits:
- Medical, dental, and vision benefits
- 401(k) retirement savings plan
- Time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
- Short-term and long-term disability
- Life insurance