UM Administration Coordinator

About the Role

The UM Administration Coordinator, National Medicaid Clinical Operations is responsible for providing administrative support to the National Medicaid Clinical Operations Authorization Team. This role involves managing documentation, coordinating communication, and ensuring the smooth operation of prior authorization processes. The Administration Coordinator works closely with clinical and nonclinical staff to facilitate 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
• Work from reports to conduct data entry into the clinical documentation system for the team
• 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 (preferred)
• Proficiency and/or experience with medical terminology and/or ICD-10 codes (preferred)
• Bachelor's Degree (preferred)
• Prior member service or customer service telephone experience (desired)
• Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization (preferred)

Work at Home Requirements

• Self-provided internet service with a minimum download speed of 25 Mbps and an upload speed of 10 Mbps; wireless, wired cable, or DSL connection suggested
• Dedicated workspace lacking ongoing interruptions to protect member PHI / HIPAA information

Schedule

40 hours per week

Pay

$40,000 - $52,300 per year

Benefits

Humana offers competitive benefits, including medical, dental, and vision insurance, 401(k) retirement savings plan, paid time off, company and personal holidays, paid parental and caregiver leave, short-term and long-term disability, and life insurance.

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.