Credentialing Representative - experience with NCQA, CAQH, auditing, enrollment - Remote

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.

Positions in this function are responsible for all activities associated with credentialing and/or enrollment of providers. Credentialing includes the processing of provider applications including initial mailing, review, and loading into the database tracking system and completing required activities through the Credentialing Committee decision. Enrollment includes the processing of payor applications for delegated, non-delegated and national providers and monitoring progress. Responsible for ensuring high quality standards are maintained and issues are identified and resolved quickly.

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

Primary Responsibilities:

• Credentialing
  • Process provider applications and re-applications including initial mailing, review, analysis and loading into the database tracking system
  • Maintain credential files through timely, accurate and complete database entries and maintenance of electronic files, as required
  • Audit files to ensure accuracy and consistency of information following SOPs, standards, and best practices to identify and correct errors at the earliest point in the credentialing process
• Enrollment
  • Complete accurate and timely payor enrollment requests
  • Follow-up on enrollments in-process (portal, telephone, email) and maintain enrollment records through timely documentation
  • Adhere to specific application requirements for each payor
  • Establish close working relationships with payer representatives and internal departments to streamline submissions and improve approval times
• All
  • Meet or exceed departmental established productivity, quality, and turn-around standards; follows department guidelines to track own work completed
  • Ensure compliance with regulatory and state requirements
  • Adheres to NCQA policies and practices

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:

• 2+ years of experience with payer enrollment applications and processes and/or 2+ years of healthcare provider credentialing experience
• 2+ years working directly with providers and administrative staff and/or healthcare representatives
• Experience identifying defects or discrepancies and providing appropriate feedback
• Intermediate level of proficiency with MS Excel and Word
• Proven excellent interpersonal and communication skills (written and verbal)
• Demonstrated solid attention to detail and strong organizational skills
• Demonstrated ability to manage shifting priorities and track open work items
• Proven ability to practice time management and prioritization skills to meet necessary deadlines with minimal supervision; seek guidance from mentors/supervisor when appropriate
• Proven ability to thrive in a completely virtual team environment

Preferred Qualifications:

• Audit experience
• Experience working with credentialing systems (i.e., Credential Stream, MD Staff)
• Knowledge of managed care and Government programs
• Knowledge of NCQA guidelines and standard practices

California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The hourly range for California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island or Washington residents is $16.00 to $31.44. 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: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment