UM Administration Coordinator

Become a part of our caring community as an Administration Coordinator supporting the National Medicaid Clinical Operations Authorization Team.

About the role

This position provides administrative support to ensure the smooth operation of prior authorization processes. The coordinator manages documentation, facilitates communication, and collaborates with clinical and nonclinical staff to enable timely and accurate prior authorization decisions.

Responsibilities

• Manage and organize documentation related to prior authorization requests, including clinical requests and receipt of clinicals.
• Maintain accurate records and ensure timely data entry into the clinical documentation system.
• Conduct data entry into the clinical documentation system using reports.
• Research participating status to ensure compliance with Humana policies.
• Verify member eligibility and benefits for prior authorization requests.
• Serve as a point of contact for internal and external stakeholders regarding prior authorization inquiries.
• Coordinate communication between healthcare providers and the prior authorization team.
• Collaborate with team members to ensure seamless integration of prior authorization processes.

Requirements

• 1+ year of administrative experience in a healthcare setting.
• Working knowledge of MS Office including Word, Excel, and Outlook.

Qualifications

• Proficiency utilizing electronic medical record and documentation programs.
• Experience with medical terminology and/or ICD-10 codes.
• Bachelor’s Degree.
• Prior member service or customer service telephone experience.
• Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization.

Work at Home Requirements

• Self-provided internet service must meet the following criteria: minimum download speed of 25 Mbps and upload speed of 10 Mbps; wireless, wired cable, or DSL connection is suggested.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI/HIPAA information.
• Occasional travel to Humana's offices for training or meetings may be required.

Schedule

Scheduled weekly hours: 40.

Pay

The pay range for this full-time (40 hours per week) position is $40,000 - $52,300 per year. The range may be higher or lower based on geographic location, and individual pay will vary based on demonstrated job-related skills, knowledge, experience, education, and certifications.

Benefits

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off, including company and personal holidays, paid parental and caregiver leave.
• Short-term and long-term disability.
• Life insurance.