Credentialing Specialist - Remote in Florida

UnitedHealth Group • Maitland, FL

12h • $18 - $32 • Remote

About The Position

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 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.
This position will be telecommute with residence in the Central Florida vicinity. The goals of our LTC network team are to manage and carry out the provider network requirements and all functions related to credentialing and re-credentialing. Provider Relations experience is a plus, Microsoft Excel intermediate to advanced level is required due to the needs of network reporting. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.

Requirements

• High School Diploma / GED
• 3+ years of experience/knowledge in the Agency for Healthcare Administration Statewide Medicaid Managed Care (SMMC) Medicaid/Long Term Care business
• 3+ years of experience working in a network management-related role, such as provider services, credentialing, contract processing
• 3+ years of experience and/or certification in ancillary credentialing, to include knowledge of credentialing requirements for the state of Florida
• 1+ years of experience in fee schedule management
• 1+ years of experience in network adequacy analysis
• Intermediate level of proficiency in Microsoft Word, Excel, PowerPoint, Databases (user-end)
• Intermediate level of proficiency with email and Internet programs such as Outlook and Teams, Chrome, Edge
• Advanced level of written and verbal English language proficiency
• Must reside in the state of Florida

Nice To Haves

• Associate’s degree or higher in Business and/or Healthcare Administration
• Experience working with Health Services staff (Care Managers) regarding authorizations and identifying in-network providers to provide services to Long Term Care members
• English/Spanish Bilingual is a plus (English being the primary language)
• Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information form others
• Strong interpersonal skills, establishing rapport and working well with others
• Strong customer service skills as this role serves as managing the incoming and outgoing communications for the Long-Term Care provider network department
• High level of organizational skills with capability to prioritize and adapt to frequently changing tasks and objectives
• Ability to work independently in a fast-paced environment with minimal support and guidance

Responsibilities

• Communicate with providers and office administrators regarding credentialing/re-credentialing, licensure and demographics, contracting efforts, etc. for the Medicaid Long Term Care business
• Positions in this function are 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
• Conducts audits and provides feedback to reduce errors and improve processes and performance
• Responsible for the development of credentialing policies and procedures
• May oversee primary source verification activities
• Key contributor to establishing and maintaining strong business relationships with Ancillary providers, ensuring the network composition includes an appropriate distribution of provider specialties
• Assist network team with tasks related to ancillary groups & facilities yielding a geographically competitive, broad access, stable network (Medicaid/Long Term Care)
• Review and submit contracts for system loading to include verification and accuracy of base agreements and payment appendices
• Distribute pertinent information to providers via FAX and EMAIL blasts such as Alerts from our State Agency, network requirement changes and/or updates, and other information related to Medicaid Long Term Care provider network management

Benefits

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED