[Hiring] Senior Credentialing Representative @UnitedHealth Group

Role Description

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.

Schedule: Monday to Friday, 6 AM-6 PM, local time

Location: Onsite - Remote, Nationally

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

Primary Responsibilities:

• Intake credentialing application review for completion and supporting documentation
• Process name and address changes
• Process initial credentialing and recredentialing applications following policy and procedures
• Process status changes following policy and procedures
• Perform primary source verifications (PSV) from various online sources according to the definition of primary source
• Data entry and maintenance into credentialing database in accordance with internal policies and procedures
• Communicate with Credentialing Committee Members, Credentialing Chair, and Chief Medical Officer (CMO)
• Provide feedback to reduce errors and improve processes
• Provide continuous monitoring of OIG/SAM/NPDB sanctions
• Support Provider Enrollment team efforts
• Develop and maintain relationships with market leadership of various levels
• Anticipate customer needs and proactively identify solutions
• Independently and as a team solve complex problems
• Be able to act without direct supervision in a virtual, fast-paced environment
• Undergo delegation and internal audits
• Other duties as assigned

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Qualifications

• High School Diploma/GED
• 2+ years of experience in allied health and/or medical credentialing processes
• 2+ years of experience with NCQA Standards relating to credentialing
• Intermediate level of proficiency with computer skills including, but not limited to: MS Office, MS Excel, MS Word, MS Outlook, Adobe Pro, and/or MS Access

Requirements

• Experience with MDStaff
• Experience with CAQH ProView
• Provider Enrollment understanding or experience
• CPCS or CPMSM Certification by NAMSS

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution (all benefits are subject to eligibility requirements)

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.