Note: The job is a remote job and is open to candidates in USA. Humana is a healthcare company that focuses on putting health first. The Utilization Management Administrative Coordinator is responsible for providing high-quality support to healthcare providers, ensuring timely and accurate processing of referral and authorization inquiries while maintaining compliance with organizational policies and regulatory guidelines.

Responsibilities

• Respond promptly and professionally to incoming calls from providers seeking to initiate referral authorizations or obtain status updates on existing requests.
• Accurately gather, verify, and enter provider and member information into the appropriate systems.
• Review and process referral authorization requests according to established UM protocols, policies, and regulatory requirements.
• Collaborate with clinical and administrative staff to resolve issues, clarify requirements, and ensure efficient case management.
• Provide clear, concise, and courteous information regarding UM processes, documentation requirements, and referral guidelines.
• Monitor call queues and manage multiple tasks to maintain service level agreements and minimize provider wait times.
• Identify and escalate complex or urgent cases to the appropriate clinical or supervisory staff as needed.
• Maintain thorough documentation of all interactions and transactions in accordance with company standards.
• Participate in ongoing training and quality assurance activities to maintain up-to-date knowledge of UM policies and procedures.
• Adhere to all applicable privacy, confidentiality, and compliance regulations.

Skills

• 1 or more years administrative or technical support experience
• Excellent verbal and written communication skills
• Working knowledge of MS Office including Word, Excel, and Outlook in a Windows based environment and an ability to quickly learn new systems
• Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); recommended speed is 10Mx1M
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
• Proficient utilizing electronic medical record and documentation programs
• Proficient and/or experience with medical terminology and/or ICD-10 codes
• Prior member service or customer service telephone experience desired
• Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization

Education Requirements

• Bachelor's Degree in Business, Finance or a related field

Benefits

• 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

Company Overview

Company H1B Sponsorship