The Administration Specialist contributes to administration of utilization management, performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.
This position will start in the office Mon-Fri, 9am-6pm and after sufficient training will then become a work from home position. The Administration Specialist provides non-clinical support for the policies and procedures ensuring best and most appropriate treatment, care or services for members. Decisions are typically focus on interpretation of area/department policy and methods for completing assignments. Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction. Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.
- Supports the daily operations of Utilization Management team through interaction with staff, facilities, vendors and providers
- Maintains a current knowledge base of Utilization Management processes and timelines
- Uses good listening skills, conducts outreach calls, collecting data according to script, tools, and protocols meeting both productivity and performance expectations as identified by departmental supervisor/or designee. Conducts all calls in a courteous and customer service friendly manner. Refers as appropriate when indicated by workflow
- Creates, updates maintains and/or closes authorizations or tasks for services as assigned within process guidelines. Routes case to appropriate Humana associates based on established guidelines
- Processes all incoming and outgoing correspondence/faxes in accordance with required standards and within respective timeliness guidelines. Refers to the appropriate clinical team members for review as defined by workflow
- Performs in a call center environment appropriately processing or triaging calls from members and providers
- Clerical responsibilities such as processing urgent scanning, mailing requests, document retrieval, and projects as assigned
- Demonstrates a professional and courteous manner when communicating with others with the ability to clearly and accurately state the agreed upon resolution
- Adhere to Humana Policies and Procedures, process standards, and Standard Operating Procedures
- Performs other related duties and projects as assigned within the assigned timeframes
- Complies with Humana and HIPAA confidentiality standards to protect the confidentiality of member information
- High School Diploma
- Proven experience in a fast paced administrative or technical support role
- Excellent verbal and written communication skills
- Strong skills in MS Word, Outlook, Excel and an ability to quickly learn new systems
- Bachelor’s Degree in Business, Finance or a related field
- Insurance or managed care experience
- Experience with Utilization Review and/or Prior Authorization
- Proficient utilizing electronic medical record and documentation programs
- Proficient and/or experience with medical terminology and/or ICD-10 codes
As part of our hiring process for this opportunity, we will be using a technology called Montage Voice which allows us to quickly connect and gain valuable information from you about your relevant experience. If you are selected for a phone screen you will receive an email inviting you to participate in a Montage Voice interview. During this call you will be asked a set of questions pertaining to this particular role and you will provide recorded responses. The entire process takes about 15-20 minutes and can be done at your convenience. Your responses will be reviewed and you will be informed if you were selected for an in person or video interview, depending on your location.
Scheduled Weekly Hours