Remote UM Compliance Coordinator III

Humana Inc; Boise (ID); Remote; USD 45.000 - 60.000; Vollzeit

Zusammenfassung

Humana, Inc. is seeking a Compliance (UM) Coordinator 3 to review utilization management activities and ensure compliance with policies and regulations.

The role involves data collection and analysis across daily, weekly, and monthly intervals to gauge team and individual performance, with independent judgment within established guidelines. Responsibilities include processing QIO fast track appeals, expedited authorizations, and ensuring accurate documentation.

Qualifikationen

• 1–3 years of technical experience.
• Proficient in Microsoft Word & Excel.
• Strong attention to detail and accuracy.
• Passionate about contributing to an organization focused on improving consumer experiences.
• Excellent verbal and written communication skills.
• Clerical support background in a healthcare environment.
• Ability to work independently in an agile environment under general instructions and within a team.

Aufgaben

• Review utilization management activities and documentation for adherence to policies and regulations.
• Analyze data daily/weekly/monthly to assess outcomes and metrics for the team.
• Follow guidelines for processing QIO fast track appeals and expedited authorizations.
• Interpret guidelines and determine appropriate actions with minimal direction.

Kenntnisse

1-3 years of technical experience

Microsoft Word & Excel

Attention to detail

Verbal and written communication

Healthcare clerical experience

Independent work in agile environment

Ausbildung

Associates' or Bachelor's degree in Healthcare, Business, Finance or related field

Familiarity with medical terminology or ICD-10 codes

Jobbeschreibung

Humana, Inc. is seeking a Compliance (UM) Coordinator 3 to review utilization management activities and ensure compliance with policies and regulations.

The role involves data collection and analysis across daily, weekly, and monthly intervals to gauge team and individual performance, with independent judgment within established guidelines. Responsibilities include processing QIO fast track appeals, expedited authorizations, and ensuring accurate documentation.