Description

The Director of Provider Credentialing is responsible for leading and managing the end-to-end provider credentialing process nationally, managing a staff of internal and external Humana associates. The objectives of this role are to meet or exceed required turnaround times, quality goals, and productivity goals, and to ensure consistency across staff performance in credentialing. It is a critical role to help us meet our growth objectives.

Responsibilities

Key responsibilities include, but are not limited to:

• motivate, manage, and lead high-performance teams involved in credentialing intake, primary source verification, re-credentialing, and data maintenance related to provider credentialing, including maintenance of external data sources
• provide input on and strategic direction over delegated credentialing
• collaborate closely with peers to resolve any escalation or conflict, including ensuring that turnaround times and provider satisfaction goals are met
• maintain standard as the subject matter expert for all things provider credentialing across all group and provider types (e.g., ancillaries, hospital systems, individual providers, groups, facilities)
• take responsibility for credentialing analysis, quality assurance, planning, client/vendor relationships and continuous improvement of operational performance
• work with compliance and quality assurance teams to ensure all relevant quality standards and operational policies/procedures are aligned with the strategic objectives and ensures legislative and policy compliance relative to credentialing (e.g., CAQH standards)
• work closely with leadership to identify and report on SLAs and credentialing team performance against SLAs
• participate in the execution of strategic plans to increase productivity in partnership with other leaders in the PPNO function

Required Qualifications

• Bachelor’s degree or higher
• 7 or more years in the healthcare industry working in the payor segment with experience working directly or indirectly with provider credentialing or enrollment
• 5 or more years of leadership experience, including of front-line staff
• Solid understanding of federal and state regulations related to credentialing and provider enrollment, including experience with and knowledge of CAQH and credentialing processes
• Knowledge of delegated credentialing and verification
• Execution-driven mindset with an openness to collaborate
• Ability to prioritize and manage across multiple tasks
• Ability to anticipate and be proactive around next steps in large initiatives simultaneously

Preferred Qualifications

• Experiencing implementing automation initiatives
• Strong knowledge of performance management skills and metrics
• Knowledge of Humana's internal policies, procedures, and systems
• Experience managing staff in international and domestic locations
• Medicaid experience

Additional Information

• Hybrid office preferred location of Louisville, KY, but remote work at home anywhere across the US will be considered. Work-At-Home Requirements: To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates 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 suggested; Satellite, cellular and microwave connection can be used only if approved by leadership; Associates 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 associates 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 information
• Requires approximately 10% travel as business needs dictate

Scheduled Weekly Hours

40

Pay Range

The 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.

$153,500 - $211,175 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, 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.