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DescriptionAs 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.ResponsibilitiesThe Senior Credentialing Professional is responsible for a thorough knowledge of credentialing standards established by the National Committee for Quality Assurance (NCQA), federal, state, local authorities and Medicaid Services to assess network provider qualifications. In this role you will leverage a combination of credentialing knowledge and collection of raw data from a variety of sources to draw valuable insights that will be used to identify trends, generate reports, clean data, resolve data issues and communicate findings to associates at all levels of the organization.Typical responsibilities, but not limited to:
Create and maintain various reports utilizing SQL
Research data elements for credentialing to understand behaviors
Extract, manipulate, research and analyze large data sets
Innovate and look for better way of creating and monitoring trends
Required Qualifications
2+ years of reporting and data analysis experience
2+ years of SQL experience- must be able to create queries, sub queries, common table expressions, temp tables, joins and unions
Prior experience utilizing advanced, comprehensive knowledge of all Microsoft Power Apps, including Power BI, Power Automate, MS Forms, MS Excel, MS Word, MS PowerPoint
Prior experience with data integration
Meet Humana's Work at Home connectivity requirements listed in additional information
Preferred Qualifications
Bachelor's Degree in Business, Mathematics, or related field
Prior state regulations pertaining to compliance in the insurance industry experience
Healthcare / insurance industry experience
Experience working with governmental agencies
Credentialing experience
Additional InformationInterview FormatAs part of our hiring process for this opportunity, we will be using an interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire 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 scheduleWork at Home Connectivity RequirementsTo 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:At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggestedSatellite, cellular and microwave connection can be used only if approved by leadershipEmployees 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 employees 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 informationHumana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana's secure website.What Humana OffersWe 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.How we Value You
Benefits starting day 1 of employment
Competitive 401k match (after 1 year)
Generous Paid Time Off accrual
Tuition Reimbursement
Parent Leave
Go365 perks for well-being
Scheduled Weekly Hours40Pay RangeThe 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 decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$63,400 - $87,400 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.Description of BenefitsHumana, 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.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=HumanaWebsite.