Credentialing and Enrollment Specialist

Requisition number: 2379613

Job category: Network Management

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 and Enrollment Specialist is responsible for activities associated with credentialing or re-credentialing physicians and providers, including processing provider applications and re-applications including initial mailing, review, and loading into the database tracking system ensuring high quality standards are maintained.

Location: Remote Nationwide

Schedule: FT, 40 hrs. Monday - Friday, 8am - 5pm

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

Primary Responsibilities:

• Apply knowledge/skills to a range of moderately complex activities

• Demonstrate great depth of knowledge/skills in own function

• Sometimes act as a technical resource to others in own function

• Meet with Medical Director to review initial and reappointment applications

• Meet with AAAHC and State Auditors to review files

• Primary Source Verification Process for initial and reappointments

• Maintain expirable for all employed and non-employed clinicians at ASCs

• Compile and generate Credentialing Committee Minutes

• Perform internal audits on credentialing and re-credentialing files for accuracy and maintaining compliance with credentialing policies and procedures

• Maintaining knowledge of and compliance with TJC, NCQA, CAQH, and CMS standards, as appropriate

• Monitoring upcoming renewal dates and working with medical staff to advise them on steps to maintain their credentials

• Proactively identify solutions to non-standard requests

• Solve moderately complex problems on own

• Work with team to solve complex problems

• Presentation skills to group setting

• Plan, prioritize, organize and complete work to meet established objectives

• May coordinate work of other team members

• Credentialing of medical group providers and hospital privileging application review and submission at the individual and group level

• Complete revalidation requests with govt and commercial payers

• Track and maintain medical professionals' licensure, certifications, etc.

• Work with other organizational departments internal/external to sure that credentialing efforts are in line with business objectives

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

• 3+ years of Healthcare Provider group/Facility Credentialing experience

• 2+ years of experience in healthcare administration, medical staff services, health information management

• 2+ years of experience with credentialing processes, medical staff privilege and knowledge of relevant software or databases used in credentialing

• Intermediate level of proficiency with Microsoft Excel and Word

• Ability to work Pacific time zone hours

Preferred Qualifications:

• Experience working with Compliance Workflows and Processes including AAAHC, JC, CMS, and NCQA Policies

• Experience in researching and applying Government Regulatory Information

• Knowledge of CAQH

• Knowledge of MD Staff credentialing databases

• Data analytics

• Pecos enrollment

• Proven ability to plan and prioritize to meet benchmarks/deadlines

*All employees working remotely 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 $29.00 to $52.00 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.

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.

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.

#RPO, #GREEN