Bilingual Compliance UM Coordinator

This is a fully remote position, open to applicants in United States.

📋 Description

• Evaluate utilization management tasks and documentation to ensure compliance with policies, procedures, and regulations.

• Gather and analyze data on a daily, weekly, monthly, or as-needed basis to evaluate team and individual performance metrics and outcomes.

• Analyze guidelines and independently decide on the best courses of action.

• Handle QIO fast-track appeals and expedited authorization requests in line with established guidelines and regulatory timeframes.

• Adhere to departmental, segment, and organizational strategies and operational goals.

• Make decisions regarding work processes in situations that may be unclear.

• Operate with minimal supervision while seeking guidance as necessary.

• Safeguard member PHI/HIPAA information while performing duties from a remote location.

⛳️ Requirements

• 1–3 years of relevant technical experience.

• Proficiency in Microsoft Word and Excel.

• Exceptional attention to detail and accuracy.

• Commitment to enhancing consumer experiences within a dedicated organization.

• Outstanding verbal and written communication abilities.

• Experience in clerical support within a healthcare setting.

• Capability to work autonomously in a dynamic environment under general guidance and as part of a team.

• Bilingual in English and Spanish with full professional proficiency; must be able to successfully complete required examinations.

• Availability to work between Monday and Sunday from 8 am to 8 pm EST.

• Must provide high-speed DSL or cable modem internet for a home office; satellite and wireless internet connections are not permitted.

• Minimum internet speeds of 25 Mbps download and 10 Mbps upload are required.

• A dedicated workspace free from interruptions to protect member PHI/HIPAA information.

• Experience in utilization management with auditing or compliance (preferred).

• Background in processing expedited requests or QIO appeals within utilization management (preferred).

• Familiarity with medical terminology and/or ICD-10 codes (preferred).

• An Associate's or Bachelor's degree in Healthcare, Business, Finance, or a related field (preferred).

🏝️ Benefits

• Medical, dental, and vision insurance coverage.

• 401(k) retirement savings plan.

• Paid time off.

• Company-designated and personal holidays.

• Paid parental and caregiver leave.

• Short-term and long-term disability coverage.

• Life insurance benefits.

• Flexible work schedule.

• Four-day work week with ten-hour shifts.

• Opportunities for occasional overtime.

• Remote work arrangement.

• Opportunities for travel related to training and meetings.