Medicaid Claims Administration Coordinator – UM, UR, PA

Job Description:

• contributes to administration of utilization management for Humana's KY Medicaid plan
• performs varied activities and moderately complex administrative/operational/customer support assignments
• provides non-clinical support for the procedures ensuring best treatment, care or services for members
• decisions are typically focus on interpretation of area/department policy and methods for completing assignments
• work within defined parameters to identify work expectations and quality standards
• follow standard policies that allow for some opportunity for interpretation/deviation and independent

Requirements:

• 2+ years of experience in medical claims
• 1+ years of Medicaid experience
• 2+ years of experience with Utilization Review (UR) and/or Prior Authorization (PA) processes within a managed care organization
• 2+ years of administrative experience or experience in a similar healthcare, insurance, or managed care role
• Working knowledge of MS Office including Word, Excel, and Outlook in a Windows-based environment and an ability to quickly learn new systems
• Proficient using electronic medical record and documentation programs
• Proficient or experience with medical terminology or ICD-10 codes
• Prior member service or customer service telephone experience

Benefits:

• medical, dental and vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance
• many other opportunities