Credentialing Assistant

Kentucky, United States

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Not SpecifiedCompensation

Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Candidates must possess at least 1 year of experience in administrative, support, data entry, or a related professional field. A minimum of 1 year of experience in a metric/production-driven environment is required, along with demonstrated proficiency in Microsoft Office Programs (Word, PowerPoint, Excel). Strong written and oral communication skills are essential. Preferred qualifications include an Associate's or Bachelor's Degree in Business, Finance, or a related field, healthcare experience, and familiarity with credentialing, contract load, service fund, directories, CIS, or provider network operations.

Responsibilities

The Credentialing Assistant will obtain and review documentation to determine provider status within the health plan, performing initial credentialing and recredentialing via APEX. This role involves correcting identified errors, contacting providers or facilities to obtain missing or expired information, and managing time effectively to meet task deadlines. The assistant will contribute to the timely credentialing and recredentialing initiatives necessary to maintain Humana's network and ensure compliance with NCQA, URAC, and state requirements.

Skills

Administrative

Support

Data Entry

Microsoft Office

Word

PowerPoint

Excel

Communication

Healthcare

Credentialing

Contract Load

Service Fund

Directories

APEX

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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