Credentialing/Enrollment Specialist – Remote

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. 

The Credentialing/Enrollment Specialist is responsible for activities associated with credentialing or re-credentialing physicians and providers, including processing provider applications and re-applications including initial mailing, review, and loading into the database tracking system ensuring high quality standards are maintained. 

You will have the flexibility to work remotely*, as well as work in the office as you take on some tough challenges.

Primary Responsibilities: 

• Apply knowledge/skills to a range of moderately complex activities
• Demonstrate great depth of knowledge/skills in own function
• Sometimes act as a technical resource to others in own function
• Proactively identify solutions to non-standard requests
• Solve moderately complex problems on own; proactively identify new solutions to problems
• Work with team to solve complex problems
• Presentation skills to group setting
• Plan, prioritize, organize and complete work to meet established objectives.
• May coordinate work of other team members
• Credentialing of medical group providers and hospital privileging application review and submission at the individual and group level
• Complete revalidation requests with govt. and commercial payers
• Track and maintain medical professionals’ licensure, certifications, etc.
• Extensive work experience within own function
• Works independently
• Perform as key team member on project teams spanning more than own function
• Work with other organizational departments internal/external to ensure that credentialing efforts are in line with business objectives
• Get ready for some significant challenge. This is a performance driven, fast paced environment where accuracy is key. You’ll be helping us confirm to very exacting standards such as NCQA, CMS and state credentialing requirements

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 or GED
• 3 + years of Healthcare Provider group/Health plan onboarding/enrollment experience
• Intermediate level of proficiency with Microsoft Office Suite (Outlook, Word, Excel, PowerPoint, Teams)
• Intermediate level of proficiency with Adobe
• Advanced level of proficiency in researching, understanding and complying with payer requirements
• Intermediate level of proficiency in managing correspondence and performing directory verifications

Preferred Qualifications:

• Primary Source Verification
• Experience with NPDB
• Experience working with Compliance Workflows and Processes including NCQA Policies and Practices.  CMS standards
• Data analytics
• Plans and prioritizes to meet benchmarks/deadlines
• Pecos enrollment
• Experience in researching and applying Government Regulatory Information
• Knowledgeable of CAQH
• Knowledge of MD Staff enrollment database
• Effective time management and ability to multi-task and shift assignments and priorities based on business need and risk
• Demonstrated ability to successfully work in a production environment and meet individual goals and metrics
• Advanced level of organizational skills
• Comfortable in a fast-paced environment with shifting tasks and responsibilities
• Keen attention to detail
• Self-starter
• Ability to work independently and as a team

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

The hourly range for this role is $28.61 to $56.06 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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. 

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