Credentialing Coordinator - Remote in Idaho
Requisition Number: 2270986
Job Category: Network Management
Primary Location: Boise, ID, US
(Remote considered)
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 equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
The Credentialing Coordinator is responsible for all activities associated with credentialing or re-credentialing physicians and providers, which include processing provider applications and re-applications including initial mailing, review, and loading into the database tracking system ensuring high quality standards are maintained. Credentialing Coordinators also conduct audits and provide feedback to reduce errors and improve processes and performance, develop credentialing policies and procedures, and may oversee primary source verification activities.
If you are located in Idaho, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:
Receive and review application and supporting documents (e.g., questionnaire; attestation form; insurance document) to determine if required and necessary information is included
Submit, enter and/or update provider information from application, prime source verification, and/or clients into applicable databases (e.g., FACETS; Advantage; CVOne)
Ensure providers have appropriate credentials and compare application information to credentialing source (e.g., state licensing website) to ensure accuracy and completeness of provider application information
Determine appropriate teams needed to provide validation of submitted information
Contact and follow-up as needed with provider to obtain missing information
Ensure verifications are completed within state, federal, and/or internally mandated timeframes (e.g., NCQA; URAC; CMS)
Perform audit of provider file to ensure documentation meets state, federal, and industry standards
Verify that appropriate signatures (e.g., provider; company representatives) on contracts have been obtained and follow corporate signature procedures
Facilitate/maintain/send correspondence (e.g., welcome letters; termination letters; rejection letters) to providers
Identify potential process improvement needs to provider application processes
Provide input into policy changes or updates and/or respond to corrective action requests regarding provider application processes and related documents
Educate internal and/or external stakeholders regarding application processes (e.g., DEA guidelines; CDS guidelines) Review application materials to determine if providers meet internal qualifying criteria for addition and/or continuation in networks
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 in the healthcare industry
1+ years of experience with provider or clinician contracting and/or credentialing
1+ years of experience with demonstrated functional knowledge of process improvement, quality improvement, and change management
Proven excellent writing skills
Research experience
Proven excellent verbal communication
Proficiency with Microsoft Office Suite to include Word, Outlook and Excel
Resident of Idaho
Preferred Qualifications:
Proven knowledgeable of the managed care/health insurance industry, products and services
Demonstrated quality knowledge of HEDIS, CAHPS
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
The hourly range for this role is $28.61 to $56.06 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.
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.
Additional Job Detail Information
Requisition Number
2270986
Business Segment
UnitedHealthcare
Employee Status
Regular
Job Level
Individual Contributor
Travel
Yes, 25 % of the Time
Country: US
Overtime Status
Non-exempt
Schedule
Full-time
Shift
Day Job
Telecommuter Position
Yes