Compliance UM Coordinator 2

Profile

Job Information

Humana

Compliance (UM) Coordinator 2

in

West Palm Beach

Florida

Description

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.

Responsibilities

The Compliance (UM) Coordinator 2 collects and analyzes data daily, weekly, monthly or as needed to assess outcome and operational metrics for the team and individuals.

Collects and analyzes data daily, weekly, monthly or as needed to assess outcome and operational metrics for the team and individuals.

Ensures mandatory reporting completed. Decisions are typically focus on interpretation of area/department policy and methods for completing assignments.

Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction.

Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.

Generates notice of adverse benefit determination in compliance with NCQA and ACHA contract requirements

Receives inbound calls and returns call for provider peer-to-peer requests. Ensures appropriate peer-to-peer handling for AHCA contract requirements and NCQA accreditation requirements

Required Qualifications

6 months working knowledge using Clinical Guidance Exchange, CGX

6 months working knowledge processing Florida Medicaid Administrative denials

1-3 years of technical experience

Proficiency in Microsoft Office applications, including Word, Excel and Outlook

Excellent verbal and written communication skills

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Additional Requirements/Adherence:

​Workstyle:

Remote work at Home Florida

Location:

West Palm Beach preferred

Hours:

Monday through Friday 8:30-5:30 Eastern Time. Must be willing to work one weekend per month, and one holiday per year

Travel:

About 5% occasional for office meetings

Remote work at Home Requirements:

Must have a separate room with a locked door that can be used as a home office to ensure you and your patients have absolute and continuous privacy while you work

Must have accessibility to hardwired high speed internet with minimum speeds of 25Mx10M for a home office (Wireless and Satellite are prohibited)

Preferred Qualifications:

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

Clerical support background in a healthcare environment

Familiarity with medical terminology and/or ICD-10 codes

Experience working in a call center environment a plus

CNA or Medical Assistant background a plus

Additional Information

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com