Remote Credentialing Specialist – Medicaid/NCQA Focus

Humana; États-Unis; À distance; USD 59 000 - 70 000; Plein temps

Résumé du poste

Humana is seeking a Credentialing Specialist to manage initial and recredentialing for providers, ensuring records are complete and compliant with NCQA, DHS, CMS, and internal policies. The role supports the WI Medicaid Market and collaborates across departments to resolve discrepancies and maintain network integrity.

The position is remote with standard CST hours, 40 hours weekly, and may require occasional travel to Humana offices for training or meetings.

Qualifications

• Associates degree or a Certified Provider Credentialing Specialist certification
• 3+ years of experience in credentialing and recredentialing
• 2 years of experience working in 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

Responsabilités

• 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: Collaborate with network development, provider relations, contracting, compliance and external credentialing vendors to resolve discrepancies to ensure providers meet participation requirements.

Connaissances

Credentialing

Recredentialing

Adobe

Microsoft Office

Formation

Associates degree

Certified Provider Credentialing Specialist certification

Outils

Adobe

Microsoft Office

Description du poste

Humana is seeking a Credentialing Specialist to manage initial and recredentialing for providers, ensuring records are complete and compliant with NCQA, DHS, CMS, and internal policies. The role supports the WI Medicaid Market and collaborates across departments to resolve discrepancies and maintain network integrity.

The position is remote with standard CST hours, 40 hours weekly, and may require occasional travel to Humana offices for training or meetings.