Provider Network/Credentialing Specialist – Remote in Florida

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

Schedule: An assigned 8-hour shift between the hours of 8:00am to 6:00pm. Monday to Friday. Potential for overtime as business needs determine.

If you reside in Florida, you will enjoy the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

• Communicate with providers and office administrators regarding credentialing/re-credentialing, licensure and demographics, contracting efforts, etc. for the Medicaid Long Term Care business
• Positions in this function are responsible for all activities associated with credentialing or re-credentialing physicians and providers
• Includes processing provider applications and re-applications including initial mailing, review, and loading into the database tracking system ensuring high quality standards are maintained
• Conducts audits and provides feedback to reduce errors and improve processes and performance
• Responsible for the development of credentialing policies and procedures
• May oversee primary source verification activities
• Key contributor to establishing and maintaining strong business relationships with Ancillary providers, ensuring the network composition includes an appropriate distribution of provider specialties
• Assist network team with tasks related to ancillary groups & facilities yielding a geographically competitive, broad access, stable network (Medicaid/Long Term Care)
• Review and submit contracts for system loading to include verification and accuracy of base agreements and payment appendices
• Distribute pertinent information to providers via FAX and EMAIL blasts such as Alerts from our State Agency, network requirement changes and/or updates, and other information related to Medicaid Long Term Care provider network management

What are the reasons to consider working for UnitedHealth Group?  Put it all together – competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
• More information can be downloaded at: http://uhg.hr/uhgbenefits

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• High School Diploma / GED (or higher)
• 2+ years of experience/knowledge in the Agency for Healthcare Administration Statewide Medicaid Managed Care (SMMC) Medicaid/Long Term Care business
• 2+ years of experience working in a network management-related role, such as provider services, credentialing, contract processing
• 2+ years of experience and/or certification in ancillary credentialing, to include knowledge of credentialing requirements for the state of Florida
• 1+ years of experience in fee schedule management
• 1+ years of experience in network adequacy analysis
• Intermediate level of proficiency in Microsoft Word, Excel, PowerPoint, Databases (user-end)
• Intermediate level of proficiency with email and Internet programs such as Outlook and Teams, Chrome, Edge
• Advanced level of written and verbal English language proficiency
• Must reside in the state of Florida

Preferred Qualifications:

• Associate’s degree or higher in Business and/or Healthcare Administration
• 3+ year experience /knowledge in the Agency for Healthcare Administration Statewide Medicaid Managed Care (SMMC) Medicaid/Long Term Care business
• 3+ years of experience working in a network management-related role, such as provider services, credentialing, contract processing
• 3+ years of experience and/or certification in ancillary credentialing, to include knowledge of credentialing requirements for the State of Florida
• 3+ years of experience in fee schedule management
• 3+ years of experience in network adequacy analysis
• Experience working with Health Services staff (Care Managers) regarding authorizations and identifying in-network providers to provide services to Long Term Care members
• English/Spanish Bilingual is a plus (English being the primary language)

Soft Skills:

• Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information form others
• Strong interpersonal skills, establishing rapport and working well with others
• Strong customer service skills as this role serves as managing the incoming and outgoing communications for the Long-Term Care provider network department
• High level of organizational skills with capability to prioritize and adapt to frequently changing tasks and objectives
• Ability to work independently in a fast-paced environment with minimal support and guidance

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

 

The salary range for this role is $16.88 to $33.22 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives. 

 

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

 

 

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

 

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.

 

 

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