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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

The Credentialing Representative is responsible for processing credentialing and recredentialing applications in accordance with department expectations, policies and procedures and regulatory requirements. This position performs internal quality review audits on credentialing files. The Credentialing Specialist is responsible for delegation oversight including data exchange, maintenance of reports and reporting schedules.  Performs delegation audits, to include review of policies and procedures and file audits ensuring compliance with CMS, NCQA, URAC and state regulations. This role is hybrid, if you live in the San Antonio area. The schedule is Tuesdays, Wednesdays and Thursdays on site, Mondays and Fridays at home.

If you live near San Antonio, Texas, you will enjoy the flexibility of a hybrid-remote position* as you take on some tough challenges.

This position follows a hybrid schedule with three in-office days per week.

Primary Responsibilities:

• Performs quality review audits on 100% of credentialing files, while maintaining a personal quality average of 95% or higher
• Takes ownership of the total work process to include system modifications and training, while providing constructive guidance to minimize problems and create efficiencies
• Maintains delegate files in accordance with the standards set forth by internal policies and procedures and external regulatory requirements
• Coordinates with all delegates to ensure timely and accurate receipt and transmission of additions, terms and changes to network physician information
• Performs annual delegation audits as well as pre-delegation assessments, including policy and procedure review and file review to ensure regulatory compliance
• Engages in development, communication and follow-up for corrective action plans for delegated providers
• Preparing weekly sign-offs, updating IntelliSoft with provider credentialing effective dates, notifying appropriate departments of provider approval and sending approval letters to providers in a timely manner
• Assists in the preparation and maintenance of departmental and IntelliSoft training materials and staff training regarding departmental procedures
• Completes required modifications to IntelliSoft to ensure proper entry of provider credentialing information
• Meets or exceed departmental timeframes and quality metrics on a consistent basis
• Ability to work onsite in an office environment in San Antonio, TX 
• Performs all other related duties as assigned

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
• 2+ years of experience working with compliance workflows and processes, including NCQA policies and practices
• Intermediate level of proficiency with Microsoft Word and Excel 

*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 $17.74 to $31.63 per hour based on full-time employment. We comply with all minimum wage laws as applicable. 

    

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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