Credentialing Representative – National 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. 

This is an opportunity that’s all about where you’ve been. Your experience. Your potential. Your skills. All pretty strong up to now. It’s also an opportunity about what’s ahead. Because on the team at UnitedHealth Group, your potential and your impact can be career changing. We’re building and maintaining extensive provider networks to serve our customers. Our goal is to attract and secure relationships with the best in every specialty and every community. As a member of our provider credentialing team, you’ll help us vet and document the competencies of physicians and other providers in our networks. As you do, you’ll discover the resources, backing and opportunities that you’d expect from a Fortune 6 leader.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. 

Primary Responsibilities: 

• Process monthly roster submissions to all payors for payor enrollment.   
• Prepare initial applications and re-applications including initial mailing, review and loading into the database tracking system.
• Responsible for monthly payer roster submissions
• Responsible for monitoring application progress and follow-up with payers as needed until confirmation is received
• Conduct audits and provide feedback to reduce errors and improve processes and performance
• Work collaboratively with the team to identify, track, and resolve provider application issues and with projects when assigned
• Work independently and assume assigned responsibilities timely
• Excellent interpersonal skills including verbal and written communications skills
• Ability to communicate effectively with our payer representative, peers and leadership via email or within our team meetings
• Resolve credentialing issues as they arise and provide updates to senior leadership
• Utilizes credentialing database to maintain credentialing data including ongoing credentialing updates, within demographics and enrollment status
• Utilizes AdHoc and recurring credentialing reports for enrollment status and roster submissions
• Apply knowledge/skills to a range of moderately complex activities
• Knowledge of revalidation request issued by all payers
• Demonstrate great depth of knowledge/skills in own function and act as a technical resource to others
• And all other duties as assigned

Making this kind of impact is no easy task. 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/GED or higher
• 3+ years of healthcare provider credentialing experience
• 1+ years’ experience working with compliance workflows and processes, including NCQA policies and practices
• 1+ years’ experience in researching and applying government regulatory information
• Intermediate level of proficiency with MS Excel and Word

Preferred Qualifications: 

• Knowledge of CAQH
• Experience managing a group mailbox
• Payer enrollment experience

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

California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island, Hawaii, Maryland, Washington, or Washington D.C Residents Only: The hourly range for California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island, Hawaii, Maryland, Washington, or Washington D.C residents is $16.54 to $32.55 per hour. 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. 

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.

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, gen

etic 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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