Compliance (UM) Coordinator

Become a part of our caring community and help us put health first

The Compliance (UM) Coordinator 2 conducts and summarizes compliance audits. The Compliance (UM) Coordinator 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.

Schedule: Two weekend shifts available

10-hour shift Thursday, Friday, Saturday, and Sunday until 6:30 PM Eastern Time

10-hour shift Saturday, Sunday, Monday, and Tuesday until 6:30 PM Eastern Time

Ability to work holidays on a rotating schedule. (about 2 holidays per year)

The Compliance (UM) Coordinator 2 generates notice of adverse benefit determination and approval letters for Medicaid Utilization Management (UM) authorization determinations in compliance with accreditation entities requirements, state contractual requirements, and organizational policies and procedures. This role works independently while meeting and maintaining the role required production and quality metrics. The role collaborates with teammates to ensure overall team success and compliance. The role analyzes report data daily, weekly, monthly, and as needed to assess and identify trends that pose a compliance risk to UM authorization determinations.

Required Qualifications

Use your skills to make an impact

Minimum 1-year data entry experienceMinimum 1-year CGX experienceStrong verbal and written communication skillsIntermediate or advanced proficiency using Microsoft Office Word, Excel, PowerPoint, navigating multiple systems and platforms and ability to troubleshoot and resolve basic technical difficulties in a remote environment

Preferred Qualifications

Work history supporting experience in healthcare Utilization ManagementWork history supporting experience issuing adverse benefit determination and/or approval letters for Utilization Management determinations to healthcare members and providersComprehensive knowledge of medical terminology, ICD10, CPT4, and/or HCPC codesComprehensive knowledge of Power BI, QikBase, QikView (QV)Knowledge of Medicaid Utilization ManagementCertified Nurse Assistant or Medical Assistant background

Additional Information

Workstyle: Remote work at home

Location: Medicaid Markets

Schedule: Two weekend shifts available

10-hour shift Thursday, Friday, Saturday, and Sunday until 6:30 PM Eastern Time10-hour shift Saturday, Sunday, Monday, and Tuesday until 6:30 PM Eastern TimeAbility to work holidays on a rotating schedule. (about 2 holidays per year)

Travel: Approximately 2 times annually for onsite meetings

Work At Home Guidance To Ensure Home Or Hybrid Home/Office Associates’ Ability To Work Effectively, The Self-provided Internet Service Of Home Or Hybrid Home/Office Associates Must Meet The Following Criteria

At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggestedSatellite, cellular and microwave connection can be used only if approved by leadershipAssociates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/jobWork from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Interview Format As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

SSN Alert Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website.

Benefits

Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:

Health benefits effective day 1

Paid time off, holidays, volunteer time and jury duty pay

Recognition pay

401(k) retirement savings plan with employer match

Tuition assistance

Scholarships for eligible dependents

Parental and caregiver leave

Employee charity matching program

Network Resource Groups (NRGs)

Career development opportunities

Scheduled Weekly Hours

40

Pay 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.

$37,200 - $51,200 per year

Description 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About Us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.

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 because he or she is a protected veteran. It is also the policy of  Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.