Credentialing Assistant

Position Overview

• Location Type: Remote
• Job Type: Full time
• Salary: Not Specified

This role involves obtaining and reviewing documentation to determine a provider's status within a health plan. The Credentialing Assistant 3 performs advanced administrative and operational duties requiring independent initiative and judgment, potentially utilizing intermediate mathematical skills. This position operates in a production-driven environment with some provider outreach via phone. The Credentialing Department is responsible for reviewing and verifying providers' credentials and qualifications to ensure they are in-network, handling both initial credentialing and recredentialing every three years. The department ensures compliance with NCQA, URAC, and state requirements for accreditation. As a Credentialing Assistant 3, you will significantly contribute to the initial credentialing and recredentialing processes for providers, helping to drive timely initiatives to maintain Humana’s network.

Requirements

• 1+ years of administrative, support, data entry, or related professional experience
• 1+ years of experience in a metric/production-driven environment
• Comprehensive knowledge and proficiency in Microsoft Office Programs including Word, Outlook, Excel, PowerPoint, and Teams
• Demonstrated ability to articulate ideas effectively in both written and oral forms
• Must meet Humana's Work at Home connectivity requirements

Responsibilities

• 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 information
• Manages personal time to accomplish all necessary tasks on time

Preferred Qualifications

• Associate's or Bachelor's Degree in Business, Finance, or a related field
• Healthcare experience
• Credentialing, Contract Load, Service Fund, Directories, or CIS experience
• Provider Network Operations or National Network Operations Experience
• Familiarity with medical terminology

Additional Information

• Work Hours: Start between 7 am-9 am EST and work M-F, 8-hour days. Candidates must be able to work in the EST time zone.
• Location: Remote within the states listed in the job posting.
• Work-At-Home Requirements:
  • Internet Service: Minimum download speed of 25 Mbps and upload speed of 10 Mbps recommended. Wireless, wired cable, or DSL connection is suggested. Satellite, cellular, and microwave connections may be used if approved by leadership.
  • Internet Expense: Associates living and working from Home in California, Illinois, Montana, or South Dakota will receive a bi-weekly payment for internet expenses.
  • Equipment: Humana will provide telephone equipment appropriate for the business requirements of the position.
  • Workspace: Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
• Interviewing Technology: HireVue will be used for the hiring process.
• SSN Information: Applicants may be asked to provide their Social Security Number. If required, an email will be sent from Humana@myworkday.com with instructions.