Senior Credentialing Representative

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.  

Perform quantitative and qualitative analysis of provider data that is located in the credentialing database, including, but not limited to internal and external reporting, maintenance, updates and data entry. The Senior Credentialing Representative position acts as an internal consultant to the organization, assisting in the development of analytic tools and reports, and providing credentialing database related support throughout Optum. Oversees and participates in the administrative aspects of credentialing services to meet medical group, plan to plan, health plan and National Committee for Quality Assurance (NCQA) requirements.

Supervision: Position does not directly supervise staff but provides oversight to maintain continuity and accuracy of data communicated internally and externally.

Location: Remote, Nationally

Schedule: Monday to Friday, 7:30 AM – 6:00 PM, PST (40 hrs./week)

Primary Responsibilities:

• Design and complete data analysis projects for department customers including defining informational needs, appropriate methodologies and report formats. Provide written reports with accompanying documentation of findings

• Conducts audits of the credentialing database, confirming accurate input of provider data, including auditing other staff data entry and verifying accuracy of modifications made to the database

• Monitor security of data within the Credentialing Database with individuals to whom data or system access may be given, report infractions to the Credentialing Supervisor

• Responsible for performing and/or supporting the onboarding and enrollment processes, as assigned

• Maintain current knowledge of computer hardware and database software capabilities

• Orient new staff to appropriate database use, capabilities, security, etc

• Act as project leader and assist in the development of provider data reporting, as requested

• Collaborate with Information Technology to review approved software installations, upgrades, incremental backups and restorations; assist in the development of configuration documentation and updates as necessary

• Maintain appropriate logs of database-related problems and modifications; monitor database performance and space; investigate and resolve all departmental problems, questions and concerns, and make modifications, as necessary

• Report on all systemic database issues to the Supervisor

• Disseminate new/modified professional information to HMOs and to internal departments through the Information System Change Control Process

• Process credentialing/recredentialing applications accurately and promptly in accordance with internal Optum policies and procedures and NCQA standards. Coordinate the credentialing and re-credentialing processes with the Quality Improvement Department and other internal departments, as necessary

• Prepare materials and files necessary to comply with external audits by health plans or governmental agencies

• Accepts and performs other duties and responsibility as assigned

Skills and Abilities:

• Must be a team player with excellent communication skills, both written and verbal

• Strong organization and administrative skills

• Attention to detail and the ability to follow through are essential

• Must be able to prioritize many tasks and exhibit excellent, mature judgment

• Excellent writing skills and attention to detail are fundamental to this position

Personal Ergonomics:

• Complies with policies and procedures, equipment orientation and workspace set up to ensure personal safety and well-being as it relates to ergonomically sound usage, reporting immediately to management any complications or difficulties regarding appropriate usage of workplace and equipment

Other Criteria:

• Comply with company and departmental administrative policies and procedures

• Performs a job safely with respect to others and to property

• Works effectively with others to encourage teamwork and productivity

• Maintains strict confidence in client information, ensuring client’s privacy; and does not discuss internal business with external entities

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)
• 1+ years of experience in credentialing or compliance

• Intermediate level of computer literacy in Windows environment with Access and Excel knowledge

Preferred Qualifications:

• 1+ years of experience in credentialing or compliance in managed care
• Knowledge of various credentialing platforms are highly desirable – MD staff
• Knowledge of Practice Management Software and Vistar Software System

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

    

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20.00 to $35.72 per hour based on full-time employment. We comply with all minimum wage laws as applicable. 

    

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. 

    

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. 

     

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.

    

   

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