Become a part of our caring community and help us put health first
 

The UM Administration Coordinator is an important support position in the administration of utilization management. This is a REMOTE work opportunity, but you must live in the state of INDIANA. This team mainly performs varied duties and moderately complex administrative, operational and customer support assignments for the state of Indiana Medicaid program. Schedule flexibility is critical for this position and an 8-hour shift may start anywhere from 8:00-11:30am and end between 5:30-8pm Eastern Time.

The UM Administration Coordinator 2 provides non-clinical support for the policies and procedures ensuring best and most appropriate treatment, care or services for members. Decisions are typically focused on interpretation of department policy and methods for completing assignments. Team members work within defined parameters to identify work expectations and quality standards, but have some latitude over prioritization/timing, and they must be able to work under minimal direction.

This position will primarily support the Medicaid and dually aligned (Medicare/Medicaid) membership in the state of Indiana but may expand to other states. Responsibilities may include but are not limited to:

• Navigating complex workflows while taking inbound calls from members and providers to build or update requests for medical and behavioral health services.
• Interact with customers and business partners to address concerns, answer questions and assist with needs, including de-escalating challenging scenarios.
• Work with inbound and outbound faxes between calls, to build or update authorizations.
• Document all call information according to standard operating procedures and attach clinical information when necessary.
• Collaboration with leadership on continuous process improvement by vocalizing frontline opportunities and suggestions for improvements.
• Any other duties assigned by leadership.

This position requires associates to be in a phone queue, which requires strict adherence to a schedule established by leadership in collaboration with Workforce Management. Success in this role requires the following key attributes:

• Excellent verbal and written communication skills.
• Ability to adapt to change and pick up new skills quickly.
• Ability to navigate complex workflows while simultaneously working in multiple systems.
• An ability to quickly learn new systems and programs.
• Critical thinking and problem-solving skills.
• Ability To de-escalate an upset caller.
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences.

Use your skills to make an impact
 

Required Qualifications

• 2 or more years of customer service or patient interaction experience
• Must reside in the state of Indiana. (*Important Note: This is a requirement for our contract with Medicaid. Moving out of the state at any time during employment in this role may lead to termination.)
• Must be able to work a shift within the hours of 7am-7pm (CST)/8am-8pm (EST) (Schedule may be 10:30a-7:00pm CST or 11:30a-8:00pm EST
• Working knowledge of MS Office including Word, Excel, and Outlook in a Windows based environment.
• Work-At-Home Requirement: Must have accessibility to high-speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); Recommended speed is 25X10-No WIFI, must use ethernet cord for connection.

Preferred Qualifications

• Proficient utilizing electronic medical record and documentation programs
• Proficient and/or experience with medical terminology and/or ICD-10 codes
• Associate degree in a Healthcare related field
• Prior member service or customer service telephone experience desired
• Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization.

Additional Information

• Must be able to sit for long periods of time.
• Remote associates are responsible for providing a designated workspace that is free from all distractions. A Work at Home audit of the workspace is required within 60 days of the beginning of the remote arrangement to determine that safe and secure work conditions exist. 
• Participants in the Remote work styles must manage all distractions, dependent care and personal responsibilities in a way that allows them to successfully meet their assignment and position responsibilities. For example, if a participant has small children, elderly family members, pets or other dependents that may distract from work or create a distraction for customers on the phone, that associate may need to create alternate caregiving arrangements