At the direction of the Manager, participates in all activities associated with delegated credentialing and recredentialing of providers in the TRICARE South Region, and Humana Government Business subsidiaries' networks. Monitors delegated organizations in processing provider applications and reapplications and policy and procedures. Monitors delegated credentialing activities in accordance with the HGB, TRICARE, and URAC Health Network Accreditation standards related to credentialing. Coordinates all activities of the delegation process, including scheduling, annual policy and file audits, data maintenance, etc. Assist with review of department policies, procedures, processes, workflows, and tools.
The Senior Credentialing Professional:
Participates in activities associated with the delegation of credentialing and credentialing
Effectively perform audits of delegated groups utilizing standardized audit tools and implantation/resolution of corrective action plans in accordance with HGB, TRICARE, URAC, and any other applicable credentialing standards
Monitoring providers in delegated organizations and reporting
Assists with reviewing, updating and maintaining credentialing policies & procedures, department workflows, tools, etc.
Assists Manager in monitoring the financial operation of delegation and strives to enhance profitability
Bachelor's degree in health care related or similar field or equivalent experience
2 - 3 years experience in a credentialing/managed care environment
Basic computer skills (Word, Windows, Excel)
Willing to travel - 50%
Preferred Location: Forum III, 305 N Hurstbourne Lane, Louisville, KY or WAH - Anywhere
Our Department of Defense contract requires U.S. citizenship for this position.
Scheduled Weekly Hours