医疗补助理赔管理协调员（UM, UR, PA）
Medicaid Claims Administration Coordinator (UM, UR, PA)
成为我们关怀社区的一员
UM行政协调员2负责Humana的肯塔基州医疗补助计划的利用管理行政工作。UM行政协调员2执行各种活动和中等复杂程度的行政/操作/客户服务任务。进行计算。通常处理半常规的任务。UM行政协调员2为程序提供非临床支持，确保会员获得最佳治疗、护理或服务。决策通常集中在对部门政策和完成任务方法的解释上。在定义的参数内确定工作期望和质量标准，但在优先级/时间方面有一定的自主权。遵循允许一定程度解释/偏离和独立性的标准政策。
用你的技能产生影响
所需资格
- 2年以上医疗理赔经验。
- 1年以上医疗补助经验。
- 2年以上在管理护理组织中使用利用审查（UR）和/或事先授权（PA）流程的经验。
- 2年以上行政经验或在类似医疗、保险或管理护理岗位的经验。
- 熟悉MS Office，包括Word、Excel和Outlook，在Windows环境中的使用能力，并能够快速学习新系统。
优先资格
- 熟练使用电子病历和文档程序。
- 熟练或有医学术语或ICD-10代码的经验。
- 有会员服务或客户服务电话经验。
其他信息
- 工作时间/时区：周一至周五，东部时间或中部时间上午8:00至下午5:00，可灵活加班。
- 工作地点：美国全国（本土）
- 工作方式：远程办公
居家办公要求：为确保居家或混合办公员工能够有效工作，居家或混合办公员工自备的互联网服务必须满足以下条件：最低下载速度25 Mbps，上传速度10 Mbps；建议使用无线、有线电缆或DSL连接。在某些职位中，Humana规定的最低推荐互联网速度可能不足以满足业务需求。Humana保留权利在必要时要求员工升级其互联网服务。在家中的专用空间工作，避免持续干扰以保护会员的PHI/HIPAA信息。
查看英文原文
Become a part of our caring community
The UM Administration Coordinator 2 contributes to administration of utilization management for Humana's KY Medicaid plan. The UM Administration Coordinator 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Perform computations. Typically work on semi-routine assignments.The UM Administration Coordinator 2 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, but has some latitude over prioritization/timing. Follow standard policies that allow for some opportunity for interpretation/deviation and independent.
Use your skills to make an impact
Required Qualifications
- 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.
Preferred Qualifications
- 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.
Additional Information
- Schedule/Time Zone: Monday through Friday, 8:00 AM – 5:00 PM ET or CT zone with flexibility to work overtime.
- Work Location: US Nationwide (Stateside)
- Work Style: Remote
Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.Scheduled Weekly Hours
40Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$40,000 - $52,300 per yearDescription of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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 and many other opportunities.
About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
Equal Opportunity Employer
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. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Originally posted on Himalayas