Compliance Coordinator, UM

🔥 24 minutes ago

🇺🇸 United States – Remote

💵 $43k - $56.2k / year

⏰ Full Time

🟢 Junior

🚔 Compliance

🚫👨‍🎓 No degree required

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Generate notices of adverse benefit determination and approval letters for Medicaid Utilization Management authorization determinations • Ensure letters comply with accreditation entity requirements, state contractual requirements, and organizational policies and procedures • Work independently while meeting required production and quality metrics • Collaborate with teammates to support overall team success and compliance • Analyze report data daily, weekly, monthly, and as needed • Identify trends that pose compliance risks to Utilization Management authorization determinations

🎯 Requirements

• 1+ year of experience in healthcare or a related field • 1+ year of data entry experience • Proficiency in Microsoft Office applications, including Word, Excel, and Outlook • Knowledge of Medicaid Utilization Management preferred • Clerical support background in a healthcare environment preferred • Familiarity with medical terminology and/or IC-10 codes preferred • CNA or Medical Assistant background a plus • Minimum download speed of 25 Mbps and upload speed of 10 Mbps • Ability to work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information • Ability to work business hours in the Eastern Standard Time Zone • Availability for a rotating schedule covering weekends and holidays

🏖️ Benefits

• Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Self-provided internet service for home employees • Remote work arrangement • Business hours in Eastern Standard Time Zone • 40 scheduled hours per week