Credentialing Representative 2 Jobs

The Credentialing Representative 2 obtains and reviews documentation to determine status in a health plan. The Credentialing Representative 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.

Responsibilities

The Credentialing Representative 2 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. Decisions are typically focus on interpretation of area/department policy and methods for completing assignments. Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction. Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.

Required Qualifications

• Understanding Primary Source Verification in the Credentialing process
• Ability to work independently in a remote environment and ability to work on a virtual team
• Proficiency with SalesForce Workflows and Activity
• Excellent communication skills, both verbal and written
• Working knowledge of computers, or a demonstrated technical aptitude and an ability to quickly learn new systems
• Experience and knowledge in CAQH Application process
• Proficiency in all Microsoft Office applications, including Word and Excel
• WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required.

Preferred Qualifications

• Previous experience in a dental provider setting (dental assistant or front office)
• Associate's or Bachelor's Degree in Business, Finance or a related field
• 2+ yrs experience in provider relations and/or credentialing

Additional Information

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Scheduled Weekly Hours

40