Compliance Coordinator, UM

This is a fully remote position, open to applicants in Florida, +7 more states.

📋 Description

• Create letters for adverse benefit determinations and approvals concerning Medicaid Utilization Management authorization decisions.

• Ensure that all letters adhere to the requirements set by accreditation entities, state contractual obligations, and organizational policies and procedures.

• Operate independently while achieving necessary production and quality standards.

• Collaborate with colleagues to promote team success and compliance.

• Analyze report data on a daily, weekly, and monthly basis, as well as whenever required.

• Identify trends that could present compliance risks to UM authorization decisions.

⛳️ Requirements

• At least 1 year of experience in healthcare or a related field.

• A minimum of 1 year of data entry experience.

• Proficiency in Microsoft Office applications, including Word, Excel, and Outlook.

• Availability to work during business hours in the Eastern Standard Time Zone.

• Willingness to adhere to a rotating schedule for weekends and holidays.

• A minimum home internet download speed of 25 Mbps.

• A minimum home internet upload speed of 10 Mbps.

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

🏝️ Benefits

• Medical benefits.

• Dental benefits.

• Vision benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays.

• Personal holidays.

• Paid parental leave.

• Paid caregiver leave.

• Short-term disability.

• Long-term disability.

• Life insurance.

• Remote work arrangement.

• Dedicated home workspace.

• Occasional travel to Humana offices for training or meetings.