Senior Credentialing Representative

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.

The Senior Credentialing Representative supports provider credentialing across multiple markets by managing end-to-end data entry, provider file preparation and system loading within MD Staff and related credentialing platforms. The position conducts audits, identifying process improvements and independently resolving complex issues. The role plays a critical part in ensuring accurate, compliant credentialing operations.

Get ready for some significant challenge. 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.

Schedule: Monday to Friday, 7 AM- 5 PM, 40 hours flexible time zone

Location: Remote - Nationwide

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

Primary Responsibilities:

• Manage end-to-end provider enrollment workflows, including roster submissions, individual enrollments, and revalidations across multiple payers
• Maintain and update provider data across systems including MD-Staff, roster templates, and payer platforms, ensuring consistency and accuracy
• Proactively track and follow up on enrollment statuses, resolving delays and preventing gaps that impact billing or network participation
• Serve as a subject matter expert on payer-specific requirements, identifying nuances and adapting processes accordingly
• Partner closely with RCM to investigate and resolve claim denials, reimbursement delays, and enrollment-related billing issues
• Conduct audits, identify root causes of errors, and support process improvements to enhance accuracy and efficiency
• Manage high-volume workloads and competing priorities, ensuring deadlines are consistently met without sacrificing quality
• Operate effectively in an evolving environment where processes and job aids change; demonstrate the ability to bring structure and clarity
• Act as a go-to resource for complex work while supporting overall team performance and success
• Take ownership of issues from identification through resolution, including cross-functional coordination when needed
• Support process improvement efforts by contributing to projects and helping refine existing workflows and team processes
• Extensive work experience, often across multiple functions (Enrollment, Credentialing, RCM)
• Work frequently requires navigating ambiguity and developing new or improved procedures
• Works independently with a high degree of accountability
• Mentors others and acts as a subject matter expert
• Coordinates activities across teams and functions
• Drives process improvements and operational efficiency

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.

Required Qualifications:

• High School Diploma/GED
• 4+ years of healthcare provider credentialing experience
• 2+ years of experience working with compliance workflows and processes, including NCQA policies and practices
• 2+ years of experience researching and applying payer and government regulatory requirements
• Intermediate level of proficiency with MS Excel and Word

Preferred Qualifications:

• MD Staff software experience
• Proven ability to manage high-volume workloads, prioritize effectively, and meet tight deadlines
• Experience partnering with Revenue Cycle Management (RCM) or resolving enrollment-related billing issues

*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). The hourly pay for this role will range from $20.38 to $36.44 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

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.