Associate-Trans Processing

Company Description:

Sutherland is seeking a reliable and detail-oriented person to join us as Quality Analyst. We are a group of driven and hard-working individuals. If you are looking to build a fulfilling career and are confident you have the skills and experience to help us succeed, we want to work with you!

Join us!

Job Description:

We're looking for a detail-oriented and compliance-focused Associate to join our Provider Recredentialing team at Humana Inc. In this role, you'll be instrumental in maintaining the integrity of our provider network by verifying and validating professional credentials. You'll combine meticulous attention to detail with a commitment to regulatory compliance, while managing provider data with precision and care. This position offers the opportunity to make a meaningful impact in a dynamic healthcare operations environment where your contributions directly support network quality and organizational compliance standards.

• Verify and validate provider demographic information, including name, address, contact details, and practice locations

• Review and authenticate provider education history, including degrees, certifications, and specialized training credentials

• Examine career history and employment records to ensure accuracy and continuity of provider background information

• Request, collect, and verify proof of current licensure from appropriate state medical boards and regulatory bodies

• Confirm provider specialties, subspecialties, and areas of clinical expertise against credentialing standards

• Complete initial credentialing applications and recredentialing renewals following established protocols and timelines

• Maintain accurate and confidential provider records, ensuring strict compliance with HIPAA regulations and organizational policies

• Process provider data while adhering to applicable confidentiality rules and data protection requirements

• Meet daily, weekly, and monthly performance targets established for individual contributors

• Multitask effectively in a fast-paced environment, managing multiple credentialing requests and administrative responsibilities simultaneously

• Collaborate with healthcare team members and external providers to obtain necessary documentation and resolve credentialing discrepancies

• Identify and escalate credential gaps, inconsistencies, or compliance concerns to supervisory personnel

• Maintain organized documentation systems to ensure all credentialing files are complete, current, and audit-ready

• Handle sensitive provider information with discretion and maintain strict confidentiality standards at all times

• Intermediate to fluent English language skills (written and verbal); ability to communicate clearly and professionally

• Proven experience in healthcare operations, provider relations, or credentialing processes, preferably in a payer environment

• Experience in US healthcare systems and familiarity with state licensure requirements and regulatory frameworks (preferred)

• Strong attention to detail with exceptional accuracy when managing provider records and sensitive information

• Excellent organizational and time management skills with the ability to prioritize multiple credentialing requests

• Demonstrated ability to work productively in a fast-paced, deadline-driven environment

• Strong problem-solving abilities with the capacity to identify and resolve credentialing discrepancies

• Exceptional interpersonal and communication skills; ability to engage effectively with diverse providers and internal teams

• Proficiency with computer systems, provider databases, and Microsoft Office Suite

• Advanced knowledge of HIPAA compliance, confidentiality requirements, and healthcare data protection regulations

• Familiarity with provider credentialing standards, Joint Commission requirements, and payer credentialing processes (preferred)

• Detail-oriented mindset with strong commitment to accuracy and regulatory compliance

• Collaborative spirit with the ability to work effectively as part of a multidisciplinary healthcare operations team

• Willingness to work US shift hours and flexibility to accommodate additional hours, overtime, or weekend work as needed

• Ability to remain focused and accurate when handling repetitive, detail-intensive credentialing tasks

• Bachelor's degree in healthcare administration, business, or a related field (preferred)

Qualifications:

• Intermediate to fluent English language skills (written and verbal)
• Proven customer service experience in a customer-centric environment, preferably in healthcare or a related field
• Strong problem-solving abilities with the capacity to think analytically and develop creative solutions
• Excellent organizational and time management skills with the ability to prioritize multiple tasks
• Demonstrated ability to work positively and productively in a fast-paced, changing environment
• Exceptional interpersonal and communication skills; articulate, professional, and able to engage effectively with diverse individuals
• Strong retention and relationship-building skills with a genuine passion for service
• Familiarity with healthcare terminology and basic understanding of healthcare operations (preferred)
• Knowledge of HIPAA compliance and patient confidentiality requirements (preferred)
• Proficiency with computer systems, electronic health records (EHR), and Microsoft Office Suite
• Bachelor's degree in healthcare administration, business, communications, or a related field (preferred)
• Ability to remain calm, empathetic, and resilient when handling challenging patient situations
• Detail-oriented mindset with strong attention to accuracy, particularly when managing patient records and sensitive information
• Collaborative spirit with the ability to work effectively as part of a multidisciplinary healthcare team
• Curiosity and willingness to continuously learn about healthcare processes and industry best practices

Additional Information:

All your information will be kept confidential according to EEO guidelines.