Credentialing Specialist - Telecommute Nationwide Details

Credentialing Specialist - Telecommute Nationwide

UnitedHealth Group - Las Vegas, NV

Employment Type : Full-Time

The more you do, the more you learn. And as you learn you find new doors opening that challenge you to bring your best. This specialist role with UnitedHealth Group will call on your knowledge, your energy and your commitment to making health care work more effectively for more people. We're building and maintaining extensive provider networks to serve our customers. Our goal is to attract and secure relationships with the best in every specialty and every community. As a senior member of our provider credentialing team, you'll help us vet and document the competencies of physicians and other providers in our networks. As you do, you'll discover the resources, backing and opportunities that you'd expect from a Fortune 6 leader.

The Credentialing Specialist is responsible for all activities associated with credentialing or re-credentialing physicians and providers. Includes processing provider applications and re-applications including initial mailing, review, and loading into the database tracking system ensuring high quality standards are maintained. Credentialing Specialists will conduct audits and provide feedback to reduce errors and improve processes and performance. Other responsibilities include the development of credentialing policies and procedures and may oversee primary source verification activities.

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

Primary Responsibilities:

• Use pertinent data and facts to identify and solve a range of problems within area of expertise
• Investigate non-standard requests and problems, with some assistance from others
• Work exclusively within a specific knowledge area
• Prioritize and organize own work to meet deadlines
• Provide explanations and information to others on topics within area of expertise
• Design and complete data analysis projects for department customers including defining informational
• needs, appropriate methodologies and report formats. Provide written reports with accompanying documentation of findings
• Conducts audits of the credentialing database, confirming accurate input of provider data, including auditing other staff data entry and verifying accuracy of modifications made to the database
• Monitor security of data within the Credentialing Database with individuals to whom data or system access may be given; report infractions to the Credentialing Supervisor
• Maintain current knowledge of computer hardware and database software capabilities
• Orient new staff to appropriate database use, capabilities, security, etc.
• Act as project leader and assist in the development of provider data reporting, as requested
• Collaborate with Information Technology to review approved software installs, upgrades, incremental backups and restorations; assist in the development of configuration documentation and updates as necessary
• Maintain appropriate logs of database-related problems and modifications; monitor database performance and space; investigate and resolve all departmental problems, questions and concerns, and make modifications, as necessary. Report all systemic database issues to Supervisor
• Disseminate new / modified professional information to HMOs and to internal departments through the Information System Change Control Process
• Process credentialing/re-credentialing applications accurately and promptly in accordance with internal medical group policies and procedures and NCQA standards. Coordinate the credentialing and re-credentialing processes with the Quality Improvement Department and other internal departments, as necessary
• Prepare materials and files necessary to comply with external audits by health plans or governmental agencies
• Accepts and performs other duties and responsibility as assigned

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 with credentialing / re-credentialing and/or privileging in the healthcare industry
• 2+ years of experience with healthcare accreditation and regulatory standards including NCQA requirements
• Intermediate or greater level of proficiency with MS Excel and Access
• Intermediate or greater level of proficiency in performing research
• Demonstrated ability to organize and manage multiple ongoing projects within expected timeframes
• If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained

Preferred Qualifications:

• Undergraduate degree
• 2+ years of experience in credentialing, preferably in a managed care setting
• Advanced Access and Excel knowledge
• Knowledge of Provider Credentialing Software and eVIPs Software System

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare’s support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.

Colorado Residents Only: The hourly range for Colorado residents is $25.63 to $45.72. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

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.

Job Keywords: Credentialing Specialist, Telecommute, Remote, Work from Home