Credentialing and Enrollment Specialist

UnitedHealth Group•Las Vegas, NV

3h•$20 - $36•Remote

About The Position

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.

Requirements

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

Nice To Haves

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

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