<h1><b>Become a part of our caring community and help us put health first</b><br> </h1>The Credentialing Professional is responsible for gathering and reviewing provider documentation to determine credentialing and health plan eligibility. This role handles a variety of work assignments that often require independent judgment, problem-solving, and interpretation of guidelines to determine next steps. The Credentialing Professional 2 works with minimal supervision and supports timely, accurate credentialing to ensure providers meet organizational and regulatory requirements.<p style="text-align:inherit"></p><p style="text-align:inherit"></p><p>The Credentialing Professional 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 department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established <span style="overflow-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">guidelines/procedures.</span></p><h1><br><b>Use your skills to make an impact </b><br> </h1><div><div><b>Required Qualifications</b></div></div><div><div><div><div><div><div><div><div><div><ul><li><p>Associate's degree or related experience</p></li><li><p>A minimum of three years of credentialing experience in healthcare</p></li><li><p>Prior work experience in an auditing function</p></li><li><p>Ability to prioritize workload to ensure deadlines are met</p></li><li><p>Excellent written and oral communication skills required.</p></li><li><p>Excellent PC skills (including MS Word, Excel and Access) required.</p></li><li><p>Must be passionate about contributing to an organization focused on continuously improving consumer experiences</p></li><li><p>Medicare and Medicaid Knowledge</p></li><li><p>Familiar with CAQH</p></li></ul><p></p><p><b>Preferred Qualifications</b></p><ul><li><p>Bachelor's degree in Business, Health Administration, Accounting or related field required.</p></li><li><p>Bilingual; English & Spanish</p></li><li><p>Experience in managed care or health care administration desired.</p></li></ul><p></p><p><b>Additional Information</b></p><ul><li><p>Remote Role</p></li><li><p>Preferred location: Florida</p></li><li><p>Standard working hours required; 8:00 am - 5:00 pm; Eastern Time Zones</p></li></ul><p></p><p><b>Work at Home Statement</b></p><p>To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:</p><ul><li><p>At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.</p></li><li><p>Satellite, cellular and microwave connection can be used only if approved by leadership.</p></li><li><p>Employees 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.</p></li><li><p>Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.</p></li><li><p>Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.</p></li></ul></div></div></div></div></div></div></div></div></div><p style="text-align:inherit"></p><p style="text-align:inherit"></p>Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.<p style="text-align:inherit"></p><p style="text-align:left"><b>Scheduled Weekly Hours</b></p><p style="text-align:inherit"></p>40<p style="text-align:inherit"></p><p style="text-align:left"><b>Pay Range</b></p>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.<p style="text-align:inherit"><br> </p>$58,700 - $70,400 per year<p style="text-align:inherit"><br> </p>This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.<p style="text-align:inherit"></p><p style="text-align:left"><b>Description of Benefits</b></p>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.<p style="text-align:inherit"></p><p style="text-align:inherit"></p><h1><br><b>About us</b><br> </h1>About Conviva Senior Primary Care: Conviva Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. As part of CenterWell Senior Primary Care, Conviva’s innovative, value-based approach means each patient gets the best care, when needed most, and for the lowest cost. We go beyond physical health – addressing the social, emotional, behavioral and financial needs that can impact our patients' well-being.<p style="text-align:inherit"></p><p style="text-align:inherit"></p>About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first – for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.<p>​<br><b>Equal Opportunity Employer</b></p><p></p><p><span>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. 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.</span></p>