Credentialing Representative in Nashville, Tennessee

Become a part of our caring community and help us put health first

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.

The Credentialing Department reviews and verifies providers’ credentials and qualifications to be in network. The department initially credential providers upon joining the network and then recredentials them every 3 years. We ensure Humana’s policy remains in line with NCQA, URAC, and state requirements to maintain accreditation. As a Credentialing Assistant 3 you will play a large role in initial credentialing and recredentialing of our providers. This is a production driven environment with some outreach to providers via phone.

Typical responsibilities, but not limited to:

• Performs initial credentialing via APEX

• Performs recredentialing via APEX

• Corrects errors as identified by leadership via APEX

• Outreaches to the provider/facility as needed to obtain missing/expired info

• Manages their own time to accomplish all necessary task on time

• Big picture – They will help drive the timely credentialing and recredentialing initiatives needed to maintain Humana’s network

Use your skills to make an impact

Additional Job Description

Required Qualifications

• 1+ years of administrative, support, data entry, or related professional experience.

• 1+ years experience in a metric/production driven environment

• Prior professional experience using Microsoft Office Programs, including Word, PowerPoint, Excel.

• Must meet Humana’s Work at Home connectivity requirements listed in additional information

Preferred Qualifications

• Associate’s or Bachelor’s Degree in Business, Finance or a related field

• Health Care experience

• Credentialing, Contract Load, Service Fund, Directories or CIS experience

• Provider Network Operations or National Network Operations Experience

• Familiarity with medical terminology and/or ICD-10 codes

Additional Information

Hours: 7a-9am start time

Training: 7:30am-4pm

Location: Virtual (within states listed on the posting)

Virtual Pre-Screen

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

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 [email protected] 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.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$34,500 – $47,400 per year

Description of 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.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

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.