Senior Credentialing Representative - Quality Auditor

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. Required 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 Preferred Qualifications Experience with MDStaff Experience with CAQH ProView Provider Enrollment understanding or experience CPCS or CPMSM Certification by NAMSS 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 $20.00 to $36.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. 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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