Credentialing Professional

CenterWell

25d • Remote

About The Position

Become a part of our caring community and help us put health first The Credentialing Professional is responsible for gathering and reviewing provider documentation to determine credentialing and health plan eligibility. This role handles a variety of work assignments that often require independent judgment, problem-solving, and interpretation of guidelines to determine next steps. The Credentialing Professional 2 works with minimal supervision and supports timely, accurate credentialing to ensure providers meet organizational and regulatory requirements. The Credentialing Professional reviews the applicant's education, training, clinical privileges, experience, licensure, accreditation, certifications, professional liability insurance, malpractice history and professional competence. Reviews the information and documentation collected, as well as verification that the information is accurate and complete. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. Use your skills to make an impact

Requirements

• Associate's degree or related experience
• A minimum of three years of credentialing experience in healthcare
• Prior work experience in an auditing function
• Ability to prioritize workload to ensure deadlines are met
• Excellent written and oral communication skills required.
• Excellent PC skills (including MS Word, Excel and Access) required.
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
• Medicare and Medicaid Knowledge
• Familiar with CAQH

Nice To Haves

• Bachelor's degree in Business, Health Administration, Accounting or related field required.
• Bilingual; English & Spanish
• Experience in managed care or health care administration desired.

Benefits

• Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being.
• Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work.
• Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree