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The Senior Credentialing Professional is responsible for identifying and implementing process improvements that support credentialing standards, deliverables, and reporting requirements established by the National Committee for Quality Assurance (NCQA), as well as federal, state, and local authorities. This role also involves ensuring compliance with various Medicaid Services programs to assess network provider qualifications.

The ideal candidate will bring deep knowledge of Medicaid regulations, provider network operations, and cross-functional leadership to support compliance, efficiency, and provider satisfaction.

Where you Come In 

The Senior Credentialing Professional is responsible for identifying and implementing process improvements that support credentialing standards, deliverables, and reporting requirements established by the National Committee for Quality Assurance (NCQA), as well as federal, state, and local authorities. This role also involves ensuring compliance with various Medicaid Services programs to assess network provider qualifications.

Key Responsibilities:

Identify and implement process improvements to support credentialing standards and requirements.

• Ensure compliance with NCQA, federal, state, and local regulations, as well as Medicaid Services programs.

• Leverage credentialing and provider process and network operations knowledge to provide oversight of credentialing functions and compliance with accrediting and regulatory agencies.

• Apply best practices to enhance credentialing processes and outcomes.

• Collaborate cross-departmentally, participating in briefings and area meetings.

• Maintain frequent contact with other managers across the provider space to ensure cohesive operations.

• Deliver executive-level briefing and status updates to leadership and governance boards and act as a liaison between operational teams, legal, regulatory compliance, and provider relations teams

What Humana Offers 
We are fortunate to offer a remote opportunity for this job.  Our Fortune 100 Company values associate engagement & your well-being.  We also provide excellent professional development & continued education.  
 

Use your skills to make an impact
 

Required Qualifications – What it takes to Succeed 

• Minimum of 3 years of experience with Medicaid credentialing procedures and standards, process improvement, compliance, risk management, and/or program implementation/design.

• History of conducting thorough research and investigations, resulting in an increase in the accuracy of outcomes and a reduction in time spent on gathering information.

• Demonstrated exceptional analytical skills by solving complex problems with a high success rate and achieving technical proficiency in using business intelligence tools.

• Successfully contextualized data to identify and resolve problems, leading to an improvement in project efficiency and a reduction in errors.

• Demonstrated excellent time management skills with proven ability to be flexible, adapt to changing environment, handle multiple tasks and deadlines and manage multiple priorities. 

Preferred Qualifications

• Commitment to continuous process improvement

• Exceptional verbal and written communication skills

• Demonstrated successful relationship building

• Experience working with cross-functional business areas

Additional Information - How we Value You
•    Benefits starting day 1 of employment 
•    Competitive 401k match  
•    Generous Paid Time Off accrual  
•    Tuition Reimbursement 
•    Parent Leave 

Work at Home 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; wireless, wired cable or DSL connection is suggested

·             Satellite, cellular and microwave connection can be used only if approved by leadership

·             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 ass