Authorization & Claims Support Specialist

Description

Humana is seeking an Authorization & Claims Support Specialist to join the Inclusa team to serve the Wisconsin Family Care (FC) program. In this role, you will be responsible for the day-to-day authorization and claims processing support. The AC Support Specialist will partner with other stakeholders to ensure excellent customer service is provided to members/providers, and services/supports are authorized and paid for in an accurate and timely manner. We are looking for an associate who is a self-starter with strong organizational skills and independent decision-making abilities.

Responsibilities

Process and support authorization entry for member services/supports in accordance with guidelines, policy and procedures. 

• Engage in training on authorization related guidelines, policy, and procedures and become proficient in their content.
• Engage in training on applicable systems and technology to enhance productivity.
• Enter the correct amount, frequency, and coding for the appropriate services from the referral or other source documentation in a timely manner.
• Routinely meet established authorization entry benchmarks and goals.
• Research referral errors and/or omissions and seek resolution in a timely manner.

Provide claims support for member services/supports in accordance with guidelines, policy and procedures. 

• Engage in training on claims related guidelines, policy, and procedures and become proficient in their content.
• Engage in training on applicable systems and technology to enhance productivity. 
• Collaborate with WPS and other stakeholders to support timely provider claim payment and to reduce the frequency of claim rejections or denials. 
• Research claim errors and/or omissions and seek resolution in a timely manner. 
• Research and support authorization and claim audit and appeal activities. 

               

Required Qualifications

• One (1)+ years of experience in Managed Care authorization or claims.

Preferred Qualifications

• Associate degree in business administration, finance, or a related field.

Additional Information

• Workstyle: Home. Home workstyle is defined as remote but will use Humana office space on an as needed basis for collaboration and other face-to-face needs.  
• Work Location: must reside in Wisconsin.
• Typical Work Days/Hours: Monday – Friday, 8:00 am – 4:30 pm CST

Limited Geography Remote - This is a remote position but located within a specific geography.

WAH Internet Statement

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Benefits

Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:

• Health benefits effective day 1
• Paid time off, holidays, volunteer time and jury duty pay
• Recognition pay
• 401(k) retirement savings plan with employer match
• Tuition assistance
• Scholarships for eligible dependents
• Parental and caregiver leave
• Employee charity matching program
• Network Resource Groups (NRGs)
• Career development opportunities

Modern Hire

As part of our hiring process for this opportunity, we will be using an interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

SSN Alert

Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the in