Licensing Credentialing Specialist - San Juan, PR

UnitedHealth Group • San Juan, PR

4h

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 Licensing Specialist, in charge of secondary filings, is responsible for running reports from BLH and analyzing these Secondary Filings using a Tracker to ensure all are accounted for. The Secondary Filings Tracker includes license expiration dates, status of filing, method of license delivery to state, and follow up notes.
This is a critical function in maintaining Medicaid provider enrollments as states can deactivate the enrollment if required documents are not received and their records updated timely. There is significant follow up involved to ensure the states have updated their records. This includes making phone calls to state Medicaid agencies and/or following up through email.
Primary Responsibilities:
In order to maintain Medicaid provider enrollments for our owned pharmacies, the Government Programs licensing team is required to supply current Board of Pharmacy licenses, city/business licenses, and DEA. This is done in a variety of ways, ie:
Logging onto a portal and updating the expiration date and uploading the current license(s)
Faxing license to the state
Emailing license to the state
Sending paper license copies to the state
Review all license notifications that are received via mail or email, ensuring that the license is accounted for on the Secondary Filings Tracker and the appropriate secondary filings are entered in BLH, and filing in the applicable pharmacy folder on the shared drive
Maintenance of the BLH database includes adding new records when additional Medicaid enrollments are approved, updating any dates based on information received from states, and running reports to confirm all required information is accurately noted in each record
Review incoming emails regarding portal password resets, access the portals and reset the passwords and update the internal Portal Password Tracker
Ensure the correct pharmacy license is provided to the state Medicaid agency including the correct pharmacy name and renewed expiration date. Verify the Medicaid ID, NPI and correct pharmacy name are included when sending pharmacy license to the state
ENGLISH PROFICIENCY ASSESSMENT WILL BE REQUIRED AFTER APPLICATION
This position is full-time (40 hours/week) Sunday- Saturday. Employees are required to have flexibility to work any of our 8 hour shift schedules during our normal business hours of (8:00am to 5:00pm Central Time). It may be necessary, given the business need, to work occasional overtime and holidays.
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.

Requirements

• 3+ years of experience within a compliance/regulatory area
• 1+ years of experience working in a Call Center setting
• Data analysis experience
• Licensure experience
• Available to work (40 hours/week) Monday- Friday during our normal business hours of (8:00am to 5:00pm Central Time)
• Familiarity with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
• Professional English proficiency (verbal and written) -English proficiency assessment will be required after application

Nice To Haves

• Experience working with CMS
• General understanding of Medicaid and Medicare

Responsibilities

• Logging onto a portal and updating the expiration date and uploading the current license(s)
• Faxing license to the state
• Emailing license to the state
• Sending paper license copies to the state
• Review all license notifications that are received via mail or email, ensuring that the license is accounted for on the Secondary Filings Tracker and the appropriate secondary filings are entered in BLH, and filing in the applicable pharmacy folder on the shared drive
• Maintenance of the BLH database includes adding new records when additional Medicaid enrollments are approved, updating any dates based on information received from states, and running reports to confirm all required information is accurately noted in each record
• Review incoming emails regarding portal password resets, access the portals and reset the passwords and update the internal Portal Password Tracker
• Ensure the correct pharmacy license is provided to the state Medicaid agency including the correct pharmacy name and renewed expiration date. Verify the Medicaid ID, NPI and correct pharmacy name are included when sending pharmacy license to the state

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 5,001-10,000 employees