Credentialing Representative

Profile

Description

As a customer-centric company, our top priority has always been the health of the people we serve. Our decades of experience helping millions of members, and our continuous learning on how to meet their evolving needs, fuels our purpose and our passion for serving our customers.

Credentialing Operations bonds the trust between patient and provider. Come join our organization and assist us in ensuring we continue to be a top choice for our members.

Responsibilities

The Credentialing Department reviews and verifies providers' credentials and qualifications to be in network. The department initially credential providers upon joining the network and then recredentials them every 3 years. We ensure Humana's policy remains in line with NCQA, URAC, and state requirements to maintain accreditation. As a Credentialing Representative you will play a large role in initial credentialing and recredentialing of our providers. This is a production driven environment with some outreach to providers.

Typical responsibilities, but not limited to:

Performs initial credentialing via APEX

Performs recredentialing via APEX

Corrects errors as identified by leadership via APEX

Outreaches to the provider/facility as needed to obtain missing/expired info

Manages their own time to accomplish all necessary task on time

Big picture - They will help drive the timely credentialing and recredentialing initiatives needed to maintain Humana's network

Required Qualifications

1 years of administrative, support, data entry, or related professional experience.

1 years experience in a metric/production driven environment

Prior professional experience using Microsoft Office Programs, including Word, PowerPoint, Excel.

Must meet Humana's Work at Home connectivity requirements listed in additional information

Preferred Qualifications

Health Care experience

Credentialing, Contract Load, Service Fund, Directories or CIS experience

Provider Network Operations or National Network Operations Experience

Familiarity with medical terminology and/or ICD-10 codes

Additional Information -

Hours: 7a-9am start time

Training: 7:30am-4pm

Location: Remote KY, IN, WI, FL, TX

Virtual Pre-Screen

As part of our hiring process for this opportunity, we will be using exciting virtual pre-screen technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected for a virtual pre-screen, you will receive an email and text correspondence inviting you to participate in a Modern Hire interview. In this virtual pre-screen, you will receive a set of questions to answer. You should anticipate this virtual pre-screen to take about 10-15 minutes.

Work at Home Connectivity Requirements

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

At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended to support Humana applications, per associate.

Wireless, Wired Cable or DSL connection is suggested.

Satellite, cellular and microwave connection can be used only if they provide an optimal connection for associates. The use of these methods must be approved by leadership. (See Wireless, Wired Cable or DSL Connection in Exceptions, Section 7.0 in this policy.)

Humana will not pay for or reimburse Home or Hybrid Home/Office associates for any portion of the cost of their self-provided internet service, with the exception of associates who live or work from Home in the state of California, Illinois, Montana, or South Dakota. Associates 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 associates with telephone equipment appropriate to meet the business requirements for their position/job.

Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review 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 information into your official application on Humana's secure website.

If you have additional questions regarding this role posting, please send them to the Ask A Recruiter by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.

#LI-Remote

Scheduled Weekly Hours

40

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Company info

Humana Inc.
Website : http://www.humana.com