Humana is hiring a Compliance UM Coordinator to ensure our Medicaid line of business meets contractual and accreditation standards. You will independently generate critical correspondence and analyze data to identify compliance risks, supporting our commitment to putting health first.
What You'll Do
- Issue notice of adverse benefit determination letters for the Medicaid line of business.
- Generate notice of adverse benefit determination and approval letters for Medicaid Utilization Management authorization determinations.
- Work independently while meeting required production and quality metrics.
- Collaborate with teammates to ensure overall team success and compliance.
- Analyze report data daily, weekly, monthly, and as needed to assess and identify trends posing a compliance risk to UM authorization determinations.
What We're Looking For
- Minimum 1-year data entry experience.
- Strong verbal and written communication skills.
- Intermediate or advanced proficiency using Microsoft Office Word, Excel, PowerPoint.
- Ability to navigate multiple systems and platforms and troubleshoot basic technical difficulties in a remote environment.
Nice to Have
- Work history supporting experience in healthcare Utilization Management.
- Minimum 1-year CGX experience.
- Work history supporting experience issuing adverse benefit determination and/or approval letters for Utilization Management determinations to healthcare members and providers.
- Comprehensive knowledge of medical terminology, ICD10, CPT4, and/or HCPC codes.
- Comprehensive knowledge of Power BI, QikBase, QikView (QV).
- Knowledge of Medicaid Utilization Management.
- Certified Nurse Assistant or Medical Assistant background.
Technical Stack
- Microsoft Office Word, Excel, PowerPoint
- Power BI, QikBase, QikView (QV)
Team & Environment
You will collaborate with teammates to ensure overall team success.
Benefits & Compensation
- Compensation: $43,000 - $56,200 per year
- Medical, dental and vision benefits
- 401(k) retirement savings plan
- Paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave
- Short-term and long-term disability
- Life insurance
Work Mode
This position is fully remote and open to candidates residing in FL, IN, KY, LA, OH, OK, SC, VA.
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status.
