Medicaid Claims Administration Coordinator – UM, UR, PA

🔥 8 minutes ago

🇺🇸 United States – Remote

💵 $40k - $52.3k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🖥️ Administration

🚫👨‍🎓 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

• contributes to administration of utilization management for Humana's KY Medicaid plan • performs varied activities and moderately complex administrative/operational/customer support assignments • provides non-clinical support for the procedures ensuring best treatment, care or services for members • decisions are typically focus on interpretation of area/department policy and methods for completing assignments • work within defined parameters to identify work expectations and quality standards • follow standard policies that allow for some opportunity for interpretation/deviation and independent

🎯 Requirements

• 2+ years of experience in medical claims • 1+ years of Medicaid experience • 2+ years of experience with Utilization Review (UR) and/or Prior Authorization (PA) processes within a managed care organization • 2+ years of administrative experience or experience in a similar healthcare, insurance, or managed care role • Working knowledge of MS Office including Word, Excel, and Outlook in a Windows-based environment and an ability to quickly learn new systems • Proficient using electronic medical record and documentation programs • Proficient or experience with medical terminology or ICD-10 codes • Prior member service or customer service telephone experience

🏖️ 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 • many other opportunities