UM Administration Coordinator - Post Acute Support

Profile

Description

Healthcare isn't just about health anymore. It's about caring for family, friends, finances, and personal life goals. It's about living life fully. At Conviva, a wholly owned subsidiary of Humana, Inc., we want to help people everywhere, including our team members, lead their best lives. We support our team members to be happier, healthier, and more productive in their professional and personal lives. We encourage our people to build relationships that inspire, support, and challenge them. We promote lifelong well-being by giving our team members fresh perspective, new insights, and exciting opportunities to enhance their careers. At Conviva, we're seeking innovative people who want to make positive changes in their lives, the lives of our patients, and the healthcare industry.

Responsibilities

Be a part of our Care Delivery Clinical Team - as a UM Administration Coordinator you will engage with the clinical team to coordinate the needed documentation and communication needed for our members to develop lifelong well-being and health and assure compliance with all regulatory requirements. Focus: Managing incoming calls from providers/members. Works with hospitals, clinics, facilities, and the clinical team to manage requests for services from members and/or providers. Process incoming referrals, and prior authorizations. Assists clinical staff with triaging cases for clinical review. Handle resolution/inquiries from members and/or providers.

Job Functions

Work with providers to obtain, prepare, and disseminate clinical information for members admitted to either acute inpatient or post-acute or facilities, adhering to standard time-frames and procedures.

Complete provider outreach within specified time-frames to obtain standard patient clinical information for all patients identified for review, per program workflow and protocols.

Complete provider outreach on a daily basis to collect discharge information for all discharges and complete updates to patient discharge information in the clinical system.

Monitor receipt of requested patient clinical information into assigned inbox and prepare for nurse use through timely identification and labeling.

Monitor receipt of census reports from facilities and complete updates or case build using pertinent patient case information in the clinical system as needed.

Complete updates to letters using the letters templates available in the system to support nurses and clinical leadership in sending the proper, timely correspondence to patients and providers.

Complete required documentation, including but not limited to: UM Activity Documentation Form, referrals to Financial Recovery, etc.

Provide general administrative support pertaining directly to clinical activities to the observation management and Concurrent Review clinical staff.

Performs other responsibilities as required.

Required Qualifications

High School diploma

3-5 Administrative Experience

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

Familiar with medical terminology

Experience in customer service

Preferred Qualifications

Associates degree or higher preferred

Health Plan experience preferred

Medicaid/Medicare experience preferred

Bilingual preferred

Alert

Conviva, a subsidiary of Humana, values personal identity protection. Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana's secure website.

Interview Format: MODERN HIRE

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

Company info

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