Credentialing Specialist - Bilingual Spanish Required- Miami, FL

Requisition number: 2365797

Job category: Network Management

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together

This position will be telecommute with occasional travel in Miami - 25% The goals of our LTC network team are to manage and carry out the provider network requirements and all functions related to credentialing and re-credentialing. Provider Relations experience is a plus, Microsoft Excel intermediate to advanced level is required due to the needs of network reporting. Microsoft Access basics is a plus. High school diploma required, prefer candidate to have Associate Degree.

In this role you will be expected to:

• Oversee/Facilitate/Complete receipt of provider applications

• Oversee/Facilitate/Complete analysis and verification of provider credentials

• Perform other assignments as required

If you are located in FL, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Gather and process Florida State Required (AHCA) Homelike Environment Assessments (HLEs)

• Analyzes and Investigates

• Prioritizes and organizes own work to meet deadlines

• Provide explanations and information to others on topics within area of expertise

• Apply basic knowledge of provider network functions, ability to work in a fast-paced environment

• Intermediate skill level in Microsoft programs (Outlook, Word, Excel) and spreadsheet management

• Ability to take initiative and use problem-solving skills for issue resolution

• Depend minimally on others for instruction, guidance or direction. Must be attentive to detail, work with flexibility, and have the capability of multi-tasking to meet deadlines and deliverables

• Possess knowledge in Medicaid and LongTerm Care programs and services

• Must have good communication skills; and the ability to build and retain relationships with Physician or Ancillary providers

• Review and process, apply functional expertise for provider/ancillary credentialing and re-credentialing

• Assist with contract management to include contract loading submissions

• Display professional work ethics in a structured work environment

• Perform other duties as required

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:

• 3+ years of experience /knowledge in the Agency for Healthcare Administration Statewide Medicaid Managed Care (SMMC) Medicaid/Long Term Care business

• 3+ years working in a network management-related role, such as provider services, credentialing, contract processing

• 3+ years of experience and/or certification in ancillary credentialing, to include knowledge of credentialing requirements for the State of Florida

• 3+ years of experience in fee schedule management

• 3+ years of experience in network adequacy analysis

• Proven excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information form others

• Proven advanced level in Excel, PowerPoint to include building spreadsheets, filtering, sorting, using pivot tables, V Lookup, conditional formatting and basic formulas. ,

• Proven solid interpersonal skills, establishing rapport and working well with others

• Proven solid customer service skills

• Bilingual - English/Spanish

*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 $28.94 to $51.63 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.