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Form of workBecome a part of our caring community and help us put health first
Are you looking to join a team where you can be a part of our important mission of supporting the TRICARE healthcare program for our nation's military and use your data skills? Humana Government Business is a top 10 Department of Defense contractor, with a long history in the TRICARE business and has recently been awarded the T-5 East Region, the next generation of military health contracts.Do you enjoy supporting beneficiaries and providers? Our team within Second Level Review is focused on ensuring time standards and proper determinations are made to best serve our Tricare providers and beneficiaries. We collaborate with many areas to ensure successful outcomes within the East Tricare Contract. If you enjoy problem solving and providing innovation solutions come join our team!
This will be a hybrid role - working some days at home and others in the office (could be at least 1 day a week), located at 101 E. Main Street, Louisville, KY. This will require candidates that live within a commutable distance to the in office location.
The UM Administration Coordinator 2 performs in a support role providing clerical fulfillment for medical management team(s). Functions include: reviewing, scanning and rerouting in-office physical mail related to appeals and other denial correspondence; reviewing and distributing returned mail for research. Will have working knowledge of claim denial codes eligible for appeal, and ability to identify denial correspondence to be directed to other departments, when applicable. Will also have responsibility for processing emails and faxes related to appeals and correspondence, as well as sending out non covered benefit letters.
Additional responsibilities will include:
Enter appropriate information into the Medical Service Review (MSR) system and other required applicable systems utilized by the Second Level Review Department.
Compose Non-Covered Benefit /Correspondence Letters and send to the print shop to be mailed via the Second Level Review Letter System
Respond to Defense Health Agency (DHA) & TRICARE Quality Monitoring Contract (TQMC) requests for documentation.
Work within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction.
Follow standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.
Success in role requires focus, being self-driven and result oriented.
Use your skills to make an impact
Required Qualifications
Our Department of Defense contract requires U.S. Citizenship
Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing)
HGB is not authorized to do work in Puerto Rico per our government contract. We are not able to hire candidates that are currently living in Puerto Rico.
Live within a commutable distance to the Clocktower Building, at 101 E. Main Street, Louisville KY
1 or more years of administrative and technical support experience.
Strong attention to detail
Capacity to maintain confidentiality and work independently in support of the department. Must be flexible, friendly, engaging, and proactive, self-directed, versatile, dependable and also able to work well in a group/team player.
Must be able to sit or stand in a stationary position for up to 8 hours.
Must be able to lift up to 30 lbs.
Excellent verbal and written communication skills
Proficient and/or experience with medical terminology and/or ICD-10 codes
Working knowledge of MS Office including Word, Excel, and Outlook in a Windows based environment and an ability to quickly learn new systems
Ability to handle multiple tasks simultaneously and to prioritize appropriately
Preferred Qualifications
Prior experience working in a Mailroom setting
Prior experience working in a managed care organization to include TRICARE
Experience with Utilization Review and/or Prior Authorization
Experience in claims
Experience with electronic medical record and documentation programs
Bachelor's Degree in Business or a related field
Prior member service or customer service telephonic experience desired
Work at Home Requirements
To ensure Hybrid Office/Home associates’ ability to work effectively, the self-provided internet service of Hybrid Office/Home associates must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
Satellite, cellular and microwave connection can be used only if approved by leadership
Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
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Scheduled Weekly Hours
40
About us
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
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