Remote Credentialing Specialist

Humana Inc; Madison (WI); Remoto; USD 59.000 - 70.000; Tempo pieno

Descrizione del lavoro

Humana Inc. is seeking a credentialing specialist to manage initial and ongoing credentialing for providers, ensuring NCQA, DHS, CMS compliance, and accurate records.

You will coordinate with network teams and audits, reporting to the Credentialing Supervisor. This role requires an associate degree or a Certified Provider Credentialing Specialist certification, 3+ years in credentialing, and proficiency with Adobe and Microsoft.

Competenze

• Associates degree or Certified Provider Credentialing Specialist certification.
• 3+ years of credentialing and recredentialing experience.
• 2 years of experience with Adobe and Microsoft applications.
• 1 year of experience with audit preparation, file reviews, and identifying documentation deficiencies.
• Understanding of NCQA requirements, DHS and CMS regulations.
• Work between 8:30-5:00pm CST, Monday through Friday.

Mansioni

• Credentialing Operations: Performing initial and recredentialing for practitioners and organizational providers following established requirements.
• Compliance and Regulatory Oversight: Ensure credentialing activities meet NCQA, state Medicaid, DHS, CMS and internal policy requirements.
• Quality and Auditing: Maintain complete, accurate credentialing records and support audits and file reviews.
• Provider Data and Network Integrity: Maintain accurate provider records, monitor ongoing credentialing requirements, and coordinate provider and practitioner status changes with appropriate departments.
• Workflows: Monitor credentialing turnaround time, resolve discrepancies, and contribute to process improvement.
• Provider and Internal Department Coordination: Colloborate with network development, provider relations, contracting, compliance and external credentialing vendors to resolve discrepancies to ensure providers meet participation requirements.

Conoscenze

Credentialing

Recredentialing

NCQA knowledge

Audit readiness

Document management

Compliance

Formazione

Associates degree

Certified Provider Credentialing Specialist certification

Strumenti

Adobe

Microsoft Office

Descrizione del lavoro

Humana Inc. is seeking a credentialing specialist to manage initial and ongoing credentialing for providers, ensuring NCQA, DHS, CMS compliance, and accurate records.

You will coordinate with network teams and audits, reporting to the Credentialing Supervisor. This role requires an associate degree or a Certified Provider Credentialing Specialist certification, 3+ years in credentialing, and proficiency with Adobe and Microsoft.