Credentialing Representative – 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.  

Optum’s Pacific West region is redefining health care with a focus on health equity, affordability, quality, and convenience. From California, to Oregon and Washington, we are focused on helping more than 2.5 million patients live healthier lives and helping the health system work better for everyone. At Optum Pacific West, we care. We care for our team members, our patients, and our communities. Join our culture of caring and make a positive and lasting impact on health care for millions.

The Credentialing Specialist job family is distinguished by the level and type of experience performing routine versus independent credentialing processes, education and training that would lead to NCQA regulatory requirements and CPCS certification and the scope of handling multiple tasking processes in an efficient manner to ensure the timely and thorough credentialing of assigned physicians. 

Schedule: Monday – Friday, 8:00AM – 5:00PM Pacific Time

Location: 2175 Park Place, El Segundo, CA. 100% fully remote.

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

Primary Responsibilities:

• Assists the Credentialing Supervisor and Credentialing Specialist II’s in gathering credentialing and re-credentialing on all providers/ancillary according to the Policies and Procedures in place for each group
• Assists in completing Medi-Care and Medi-Cal provider applications for all newly employed credentialed providers for select groups
• Assists in tracking and maintaining of all provider licensure and updating provider database with all current information
• Assists in the maintenance of filing for all providers credentialing files
• Assists Credentialing Supervisor and internal staff with any special projects or requests from Health Plans or State programs regarding credentialing issues
• Assists in compliance with Meaningful Use tasks
• Processes the credentialing and re-credentialing on all providers according to the Policies and Procedures in place for each group
• Maintains all physician provider files and provider database files with current information and documentation
• Works with health plans, hospitals, and other healthcare organizations to provide current physician information on all employed and contracted providers, and with hospitals to ensure current staff privileges for all initial appointment and reappointment employed physicians
• Tracks provider licensure for all employed and contracted providers including frequent interaction with the Accounts Payable department
• Assists the Credentialing Supervisor in the preparation of NCQA, IMQ, and other related health plan audits of provider credentialing files
• Attends and supports the Credentials Committee

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)
• 1+ years of experience working in an office, customer service, or in the medical field
• 1+ years of recent credentialing experience in a managed care organization, IPA/Medical Group organization and/or hospital setting, which included provider database processing

Preferred Qualifications:

• 1+ years of work clerical or administrative experience in a healthcare setting
• 1+ years of clerical/administrative experience in a managed care organization, IPA/Medical Group organization and/or hospital setting
• Basic knowledge of medical terminology 
• Solid multitasking and typing skills

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

 

California Residents Only: The hourly range for California 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.   

 

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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