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Humana · 5 hours ago

Credentialing Professional

United States

Full-time

Remote

Mid Level

$59K/yr - $70K/yr

3+ years exp

Humana, through its subsidiary Conviva Care Solutions, is seeking a Credentialing Professional to join their caring community. The role involves gathering and reviewing provider documentation to ensure credentialing and health plan eligibility, requiring independent judgment and adherence to guidelines.

Health CareHealth InsuranceInsuranceVenture Capital

Responsibilities

Gather and review provider documentation to determine credentialing and health plan eligibility

Handle a variety of work assignments that often require independent judgment, problem-solving, and interpretation of guidelines to determine next steps

Work with minimal supervision and support timely, accurate credentialing to ensure providers meet organizational and regulatory requirements

Review the applicant's education, training, clinical privileges, experience, licensure, accreditation, certifications, professional liability insurance, malpractice history and professional competence

Review the information and documentation collected, as well as verification that the information is accurate and complete

Understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas

Make decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed

Follow established guidelines/procedures

Qualification

Credentialing experienceMedicareMedicaid KnowledgeAuditing experiencePC skillsBilingualPrioritize workloadFamiliar with CAQHEnglish & SpanishCommunication skills