Compliance Coordinator, UM

Humana

Humana Medicaid Compliance Coordinator issuing utilization-management determination letters and approval notices. Analyzing reports and compliance trends while meeting production and quality metrics remotely nationwide.

Posted 8/5/2026full-timeRemote • 🇺🇸 United StatesJunior💰 $43,000 - $56,200 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates proficiency in Medicaid Utilization Management processes and compliance with accreditation and state requirements, while effectively managing data entry and analysis in a healthcare environment.

Highest-signal resume keywords

Medicaid Utilization ManagementData Entry ExperienceMicrosoft Office ProficiencyMedical Terminology KnowledgeClerical Support Background

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Data AnalysisReport GenerationICD-10 Codes KnowledgeQuality Metrics ComplianceProduction Metrics Management

Soft Skills

CollaborationIndependent WorkAttention to Detail

Tools & Technologies

Microsoft WordMicrosoft ExcelMicrosoft Outlook

Certifications & Qualifications

CNAMedical Assistant

Industry Keywords

HealthcareUtilization ManagementPHIHIPAAAccreditation Compliance

About the role

Key responsibilities & impact

Generate notices of adverse benefit determination and approval letters for Medicaid Utilization Management authorization determinations
Ensure letters comply with accreditation entity requirements, state contractual requirements, and organizational policies and procedures
Work independently while meeting required production and quality metrics
Collaborate with teammates to support overall team success and compliance
Analyze report data daily, weekly, monthly, and as needed
Identify trends that pose compliance risks to Utilization Management authorization determinations

Requirements

What you’ll need

1+ year of experience in healthcare or a related field
1+ year of data entry experience
Proficiency in Microsoft Office applications, including Word, Excel, and Outlook
Knowledge of Medicaid Utilization Management preferred
Clerical support background in a healthcare environment preferred
Familiarity with medical terminology and/or IC-10 codes preferred
CNA or Medical Assistant background a plus
Minimum download speed of 25 Mbps and upload speed of 10 Mbps
Ability to work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information
Ability to work business hours in the Eastern Standard Time Zone
Availability for a rotating schedule covering weekends and holidays

Benefits

Comp & perks

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
Self-provided internet service for home employees
Remote work arrangement
Business hours in Eastern Standard Time Zone
40 scheduled hours per week