Senior Credentialing Professional - Medicaid Implementation - Remote Eligible

Join Our Caring Community

Become a part of our caring community and help us put health first. 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 associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Interview Format

As part of our hiring process for this opportunity, we will be using an exciting 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. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

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.

$65,000 - $88,600 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements.