Remote Credentialing Specialist - NCQA & Audits

Humana Inc; Wisconsin; Hybride; USD 59 000 - 70 000; Plein temps

Résumé du poste

Humana Inc. is seeking a Credentialing Specialist to manage credentialing and recredentialing for providers serving the Wisconsin Medicaid market.

You will maintain accurate provider records, support audits, ensure compliance with NCQA, DHS and CMS requirements, and coordinate with multiple internal departments and external vendors. The role emphasizes quality data, timely workflows, and collaboration across network development, provider relations, and compliance.

Qualifications

• Associates degree or Certified Provider Credentialing Specialist certification.
• 3+ years in credentialing and recredentialing.
• 2 years using Adobe and Microsoft applications.
• 1 year in audit prep, file reviews, and identifying deficiencies.
• Understanding of NCQA, DHS and CMS regulations.
• Mon-Fri 8:30-17:00 CST.

Responsabilités

• Credentialing operations: initial and recredentialing for practitioners and organizational providers.
• Compliance oversight: NCQA, Medicaid, DHS, CMS and internal policy alignment.
• Quality and auditing: maintain credentialing records and support audits.
• Provider data and network integrity: keep records accurate and monitor requirements.
• Workflows: monitor turnaround times and drive process improvements.
• Coordination: collaborate with networks, contracting, compliance and external vendors.

Connaissances

Credentialing

Recredentialing

NCQA knowledge

Microsoft Office

Formation

Associates degree

Certified Provider Credentialing Specialist

Outils

Adobe

Microsoft 365

Description du poste

Humana Inc. is seeking a Credentialing Specialist to manage credentialing and recredentialing for providers serving the Wisconsin Medicaid market.

You will maintain accurate provider records, support audits, ensure compliance with NCQA, DHS and CMS requirements, and coordinate with multiple internal departments and external vendors. The role emphasizes quality data, timely workflows, and collaboration across network development, provider relations, and compliance.