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Medicaid Claims Administration Coordinator – UM, UR, PA

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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
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