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Summary:
The Credentialing Auditing Assistant audits credentialing files to help Humana meet accreditation and state requirements. The role ensures compliance with NCQA, URAC, and state policies while supporting credentialing operations.
Responsibilities:
- Audit credentialing files to ensure compliance with accreditation and state requirements.
- Work with supervisors to educate teams on accreditation standards.
- Maintain documentation related to credentialing processes.
- Manage the approved board certification list for Humana.
- Share audit findings with credentialing leaders and assist in process improvements.
Requirements:
- At least 1 year of experience in healthcare administration, support, or data entry within the last 5 years.
- Minimum 1 year of experience in a metric/production-driven environment.
- Proficiency in Microsoft Office, including Word, PowerPoint, and Excel.
- Preferred experience in credentialing, peer audits, contract load, service funds, and provider network operations.
- Familiarity with medical terminology is a plus.
Benefits:
- 401(k) retirement plan.
- Caregiver leave.
- Dental, health, and life insurance.
- Disability insurance.
- Paid holidays.
