Compliance (UM) Coordinator

Humana; South Carolina; Remote; USD 43,000 - 56,000; Full time

Job summary

Humana is seeking a Compliance (UM) Coordinator to issue adverse benefit determination letters for Medicaid UM determinations, ensuring adherence to accreditation and contractual requirements. This role works independently to meet production and quality metrics while supporting team compliance.

The position is remote with occasional travel to Humana offices for training or meetings. Hours are 40 per week, with a compensation range of $43,000–$56,200 per year.

Qualifications

• 1+ year of experience in healthcare or related field.
• 1+ year of data entry experience.
• Proficiency in Microsoft Office applications, including Word, Excel and Outlook.

Responsibilities

• Generates notice of adverse benefit determination and approval letters for Medicaid UM determinations in compliance with requirements.
• Works independently while meeting production and quality metrics.
• Collaborates with teammates to ensure overall team success and compliance.
• Analyzes report data daily, weekly, monthly to identify trends posing compliance risks.
• Work hours will be business hours in EST with rotating schedule for weekends/holidays.

Skills

Healthcare experience

Data entry

MS Office

Job description

Become a part of our caring community

The Compliance (UM) Coordinator issues notice of adverse benefit determination letters for Medicaid line of business to ensure adherence to contractual and accreditation requirements.

Become a part of our caring community

The Compliance (UM) Coordinator issues notice of adverse benefit determination letters for Medicaid line of business to ensure adherence to contractual and accreditation requirements.

The Compliance (UM) Coordinator

• 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
• Collaborates with teammates to ensure overall team success and compliance
• Analyzes report data daily, weekly, monthly, and as needed to assess and identify trends that pose a compliance risk to UM authorization determinations
• Work hours will be business hours in Eastern Standard Time Zone, with rotating schedule for weekends/holidays

Required Qualifications

Use your skills to make an impact

• 1+ year of experience in healthcare or related field
• 1+ year of data entry experience
• Proficiency in Microsoft Office applications, including Word, Excel and Outlook

Preferred Qualifications

• Knowledge of Medicaid Utilization Management
• Clerical support background in a healthcare environment
• Familiarity with medical terminology and/or IC-10 codes
• CNA or Medical Assistant background a plus

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

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.

$43,000 - $56,200 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, 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 atHumana.comand atCenterWell.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.