[Hiring] Compliance Coordinator 3 @Humana

Role Description

The Compliance (UM) Coordinator 3 reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations. The Compliance (UM) Coordinator 3 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

PLEASE NOTE: This role will follow a four-day, 10-hour shift schedule within a Wednesday through Sunday work week. The assigned schedule will be either Wednesday through Saturday or Thursday through Sunday, with work hours scheduled between 8:00 a.m. and 8:00 p.m. Eastern Time.

• Collects and analyzes data daily, weekly, monthly, or as needed to assess outcome and operational metrics for the team and individuals.
• Understands department, segment, and organizational strategy and operating objectives, including their linkages to related workstreams.
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.
• Assignments are varied and often complex, requiring independent judgment, critical thinking, and interpretation of guidelines to determine appropriate courses of action.
• Follows established guidelines, regulatory turnaround times, and procedures for processing QIO fast track appeals and expedited authorization requests.

Qualifications

• 1 - 3 years of technical experience
• Proficient in Microsoft Word & Excel
• Strong attention to detail and accuracy
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
• Excellent verbal and written communication skills
• Clerical support background in a healthcare environment
• Ability to work independently in an agile environment under general instructions and within a team.

Requirements

• UM experience with auditing or compliance
• UM experience with processing expedited requests or QIO appeals
• The ideal candidate for this opening would be a current member of the One Home / Home Solutions UM Team who has been in their current position for 12+ months
• Associates' or Bachelor's degree in Healthcare, Business, Finance, or related field
• Familiarity with medical terminology and/or ICD-10 codes

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

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$44,900 - $60,200 per year

Work-At-Home Requirements

• 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 is 25mbs download x 10 mbs upload is required.
• A dedicated office space lacking ongoing interruptions so you can meet productivity requirements, and to protect member PHI / HIPAA information.
• In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel

While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.