Compliance UM Coordinator 2

Profile

Job Information
Humana
Compliance (UM) Coordinator 2
in
Dover
Delaware
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.
Job Responsibilities
*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
Required Qualifications
1 year working knowledge of CGX Authorization
1 year Data Entry Experience
Proficiency in Microsoft Office applications, including Word, Excel and Outlook
Excellent verbal and written communication skills
Must be available to work one of the following shifts in the Eastern Time Zone:
Monday - Friday 8:30 - 5:30 EST and 1 weekend per monthMonday - Friday 9:00-6:00 EST with rotating 1 weekend per monthFriday - Monday four 10 hour shifts ESTWednesday - Saturday four 10 hour shifts ESTSunday - Wednesday four 10 hour shifts ESTAll shifts require working 1 Holiday per year
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
Must have a separate room with a locked door that can be used as a home office to ensure you and your members have absolute and continuous privacy while you work.
Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required.
Scheduled Weekly Hours
40

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