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Description

The Compliance (UM) Coordinator 3 conducts and summarizes compliance audits

Responsibilities

The Compliance (UM) Coordinator 3 collects and analyzes data daily, weekly, monthly or as needed to assess outcome and operational metrics for the team and individuals.

  • Triage all denials in the Auditor queue in CWAS to determine Priority, Case Type, and Language Preference. Confirm details of the auth request in CSC to identify and correct any errors in CWAS.

  • Assign denials each day to the auditors.

  • Triage CWAS queue throughout the day to identify any denials that need to be assigned.

  • Monitor emails to triage Unable to Contact (UTC) requests, G&A letter requests, Inpatient Denial requests, and 100 day letter requests. Keep a running list to ensure assignment to Auditors is rotated.

  • Ensure denials are triaged and assigned to maintain compliance with timeframes.

  • Monitor RAD reports to ensure there are no inappropriate cases being sent to the plan for review.

  • Assist with updating Precert DME job aids and resources.

  • Responsible for monitoring DME delegate reporting

Required Qualifications

  • Experience routing authorizations
  • Familiar with DME process
  • CSC experience
  • 1 or more years of UM experience
  • Proficient in Microsoft Word & Excel
  • Experience in a production driven environment

Preferred Qualifications

  • Experience with CarePlus process
  • Experience with CWAS
  • Strong attention to detail and accuracy
  • Service Operations experience
  • Medicare experience
  • Strong Analytical skills

Additional Information

As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, 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.

Work at Home Guidance

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office 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

Internal- If you have additional questions regarding this role posting, please send them to the Ask A Recruiter persona by visiting go/yammer and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.

#LI-BB1

Scheduled Weekly Hours

40



Request an Accommodation

If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact yourcareer@humana.com for assistance.

Employment Fraud Notice

Humana will never ask a candidate for money for work equipment and network access or request access to personal accounts during the application process. Learn more about identifying and preventing employment fraud or report a suspected employment fraud case.

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Our Hiring Process

Apply online

To be considered for a job, you must apply online. Unfortunately, we cannot accept resumes that have been emailed to us. Once you find a job that interests you, simply select “Apply.” It typically takes 15 minutes to fill out the application form. Be sure to update your resume and upload it as you cannot edit the resume or add it after the application has been submitted. Shortly after you submit your application, you will receive a confirmation.

Next Step

If selected to continue with the interview process, you will be contacted through text or email to complete an assessment or schedule an initial live or recorded phone or video interview.

A hiring manager interview

After hiring managers and interview teams carefully consider the skills and experiences of applicants, they contact the top candidates via email or phone to schedule an interview.

Offer from Humana

If you’ve successfully completed the interview process and are identified as the candidate we would like to hire, you will receive an offer from our Talent Acquisition team.

Onboarding

If you accept the offer to join our Humana team, you will receive a welcome call or email to begin the onboarding process.


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Hiring Process