Credentialing Professional

Profile

Job Information

Humana

Credentialing Professional

in

Boston

Massachusetts

Description

The Credentialing Professional obtains and reviews documentation to determine status in a health plan. The Credentialing Professional work assignments are often straightforward and of moderate complexity.

Responsibilities

About Us

Healthcare isn't just about health anymore. It's about caring for family, friends, finances, and personal life goals. It's about living life fully. In the Primary Care Organization, a division of Humana, we want to help people everywhere, including our associates, lead their best lives. We support our associates to be happier, healthier, and more productive in their professional and personal lives. We encourage our people to build relationships that inspire, support, and challenge them. We promote lifelong well-being by giving our associates fresh perspective, new insights, and exciting opportunities to grow their careers. We're seeking innovative people who want to make positive changes in their lives, the lives of our members, and the healthcare industry as a whole.

The Role

The Credentialing Professional 1 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 own work area professional concepts/standards, regulations, strategies and operating standards. Makes decisions regarding own work approach/priorities, and follows direction. Work is managed and often guided by precedent and/or documented procedures/ regulations/professional standards with some interpretation.

Vaccine Policy

For this job, associates are required to be fully COVID vaccinated, including booster or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.

If progressed to offer, you will be required to:

Provide proof of full vaccination, including booster or commit to testing protocols

OR  

Provide proof of applicable exemption including any required supporting documentation

​​Medical, religious, state and remote-only work exemptions are available.

Required Qualifications:

Associate's degree or related experience

A minimum of two years of credentialing experience in healthcare

Ability to learn credentialing software; ability to complete reporting

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

Preferred Qualifications

Bachelor's degree in Business, Health Administration, Accounting or related field required.

Bilingual; English & Spanish

Experience in managed care or health care administration desired.

Interview Format

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice 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 first round interview, you will receive an email correspondence inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Alert:

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

Scheduled Weekly Hours

40

Company info

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