Credentialing Lead

Profile

Description

As a customer-centric company, our top priority has always been the health of the people we serve. Our decades of experience helping millions of members, and our continuous learning on how to meet their evolving needs, fuels our purpose and our passion for serving our customers.

Credentialing Operations bonds the trust between patient and provider. Come join our organization and assist us in ensuring we continue to be a top choice for our members.

Responsibilities

The Credentialing Medicaid Implementation Lead (the Lead) reviews the findings from the proposed contracts and writes correlating Policies and Procedures to fulfill the requirements. The Lead will also ensure and work in tandem with many business partners to ensure that system enhancements, if needed, are turned on time, or what workaround will be needed while documenting the process for the operational teams to be successful.

The Lead will ensure that documentation for Operational Teams is completed and accurate according to the state requirements outlined in Policy and Procedures as well as timely execution of training to get work completed on time. This includes but not limited to, the information provided on 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.

Advises executives to develop functional strategies (often segment specific) on matters of significance, including but limited too: staffing, system enhancements and outcomes of those enhancements.

The Lead will work very closely with the Implementation Lead on meeting or exceeding timeline expectations of state requests as well as being a SME to the operational team.

Additionally, a portion of this associates responsibilities will be a leading Direct Reports.

Desired skillset:

Attention to detail and time management skills

Ability to prioritize competing priorities

Strong written and verbal communication skills

Demonstrated relationship building skills

Required Qualifications

5 or more years of compliance or related experience

2 or more years of project leadership experience

Prior credentialing experience (preferably Medicaid)

Prior business consulting and/or operational leadership experience; preferably for an auditing function/compliance function

Prior professional experience with working knowledge in regulations governing health care industries

Prior professional experience utilizing Microsoft Office applications (Word, Excel etc.)

Meet Humana's Work at Home policy listed in additional information

Preferred Qualifications

Bachelor's degree or Master's Degree in related field

Additional Information

Hours: 7a-9am start time

Location: Remote Nationwide

Virtual Pre-Screen

As part of our hiring process for this opportunity, we will be using exciting virtual pre-screen technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected for a virtual pre-screen, you will receive an email and text correspondence inviting you to participate in a Modern Hire interview. In this virtual pre-screen, you will receive a set of questions to answer. You should anticipate this virtual pre-screen to take about 10-15 minutes.

Work at Home Connectivity Requirements

To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended to support Humana applications, per associate.

Wireless, Wired Cable or DSL connection is suggested.

Satellite, cellular and microwave connection can be used only if they provide an optimal connection for associates. The use of these methods must be approved by leadership. (See Wireless, Wired Cable or DSL Connection in Exceptions, Section 7.0 in this policy.)

Humana will not pay for or reimburse Home or Hybrid Home/Office associates for any portion of the cost of their self-provided internet service, with the exception of associates who live or work from Home in the state of California, Illinois, Montana, or South Dakota. Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide their social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana's secure website.

If you have additional questions regarding this role posting, please send them to the Ask A Recruiter by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.

#LI-Remote

Scheduled Weekly Hours

40

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Company info

Humana Inc.
Website : http://www.humana.com