Senior Credentialing Professional - TRICARE

Profile

Description

Responsibilities

Participates in all activities associated with delegated credentialing and recredentialing of providers in the TRICARE East 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.

Key Accountabilities -


Participate in activities associated with the delegation of credentialing and recredentialing
Effectively perform audits of delegated groups utilizing standardized audit tools and implementation/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


Required Qualifications


Our Department of Defense contract requires U.S. citizenship for this position
Bachelor's degree in health care related or similar field or equivalent credentialing experience
2 - 3 years of experience in a credentialing and/or managed care environment working with providers and have familiarity with credentialing process
Willing to travel up to 30% of the time
Excellent written and verbal communication skills
Proficient with Microsoft Office products
Must be passionate about contributing to an organization focused on continuously improving consumer experiences


Preferred Qualifications


Credentialing Certification (CPCS)
Advanced degree in Healthcare Analytics, Business Analytics, or related field


Scheduled Weekly Hours

40

Company info

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