Credentialing Specialist - Remote

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. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life's best work.(sm)

Positions in this function are responsible for all activities associated with credentialing or re-credentialing physicians and providers. Includes processing provider CAQH applications and re-applications including, loading into the database tracking system ensuring high quality standards are maintained. Conducts audits and provides feedback to reduce errors and improve processes and performance. Responsible for Medicare and Medicaid Enrollment for all providers.

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

Primary Responsibilities:

• Uses pertinent data and facts to identify and solve a range of problems within area of expertise
• Investigates non-standard requests and problems, with some assistance from others
• Works exclusively within a specific knowledge area/skill in own function
• Prioritizes and organizes own work to meet deadlines
• Provides explanations and information to others on topics within area of expertise
• Assists in tracking and maintaining of all provider licensure and updating provider database with all current information
• Assists in the maintenance of filing for all providers credentialing files
• Assists Credentialing Supervisor and internal staff with any special projects or requests from Health Plans or State programs regarding credentialing issues
• Assists in compliance with Meaningful Use tasks
• Processes the credentialing and re-credentialing on all providers according to the Policies and Procedures in place for each group
• Maintains all physician provider files and provider database files with current information and documentation
• Works with health plans, hospitals, and other healthcare organizations to provide current physician information on all employed and contracted providers, and with hospitals to ensure current staff privileges for all initial appointment and reappointment employed physicians
• Tracks provider licensure for all employed and contracted providers including frequent interaction with the Accounts Payable department
• Assists the Credentialing Supervisor in the preparation of NCQA and other related health plan audits of provider credentialing files
• Attends and supports the Credentials Committee
• Applies knowledge/skills to a range of moderately complex activities
• Proactively identifies solutions to non-standard requests
  

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, or equivalent experience
• 2+ years of recent credentialing experience
• 1+ years of experience working in a customer service, or in the medical field
• Ability to work an 8-hour shift between the hours of 8:00am - 5:00 pm local time
  

Preferred Qualifications:

• 2+ years of work clerical or administrative experience in a healthcare setting
• Basic knowledge of medical terminology
• Organization and/or hospital setting, which includes provider database processing
• Solid multitasking and typing skills
  

Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.

California, Colorado, Connecticut, Nevada, New York City, or Washington Residents Only: The hourly range for California, Colorado, Connecticut, Nevada, New York City, or Washington residents is $27.07 to $53.08. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

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.