Provider Enrollment & Credentialing Specialist

UnitedHealth Group • Boston, MA

6d • $18 - $32 • Hybrid

About The Position

Under general direction, is responsible for the initial and re-credentialing of providers as well as provider changes. Serves as the primary person to ensure accuracy and timing of the entire provider enrollment/credentialing process from the time that the provider submits the credentialing or change information to the time the provider is enrolled in the appropriate Atrius Health systems. This is a performance driven, fast paced environment where accuracy is key. You'll be helping us confirm to very exacting standards such as NCQA, CMS and State credentialing requirements.

Requirements

• High School Diploma/GED
• 2+ years of credentialing/payer enrollment experience in a health plan or medical staff services setting
• Intermediate level of proficiency with Microsoft Office applications including Excel and Word
• Proven ability to manage and process detailed information.
• Successful candidate must possess excellent organizational and communication skills, both written and oral and must also display well-developed interpersonal skills in order to work successfully with all levels of management and staff both internally and externally
• Strong attention to detail and accuracy
• The ability to work independently is also required

Nice To Haves

• Bachelor’s Degree in Health Care Administration or related field preferred
• National Certified Provider Credentialing Specialist Certification preferred
• Previous experience with MD Staff credentialing database

Responsibilities

• Accountable for the accuracy and timeliness of the entire process of obtaining, reviewing, submitting and tracking provider application, recredentialing and change paperwork
• Expedites information gathering by working with individual clinicians as well as specialty administrators, chiefs and/or medical directors
• Acts as liaison to physician recruitment and clinical practice supervisors/managers on matters related to credentials, licensure, hospital affiliations and provider numbers for assigned areas
• Facilitates, tracks and follows through with paperwork needed for clinicians to obtain initial hospital privileges (appointments)
• Responsible for tracking license, DEA, malpractice face-sheet and other certification renewals as well as keeping current copies on file
• Performs self-audit on credentialing work to assess quality, service and performance of end product to minimize the back and forth or phone calls from providers, payors and hospitals
• Conducts proactive audits and system reviews to ensure the accuracy of provider information in all systems (e.g., data on Atrius Health website, credentialing database, credentialing fields in Resolute). Review and monitor standard reports to communicate back to the sites regarding enrollment of providers under the specialist’s jurisdiction
• Identify areas of redundancy or areas that need to be standardized or streamlined vis a vis the payors, hospitals or changing industry standards. Brings issues to attention of supervisor and may make recommendations on improvements
• Reports to specialty and practice location when clinicians are credentialed and entered into the appropriate system/s for scheduling and billing
• Maintains complete and up to date credentialing file for all providers that require credentialing
• Interacts with internal departments to ensure systems have the proper insurance information and that clinician credentialing is aligned with the terms of the payor contracts
• Develops and builds collaborative relationships to handle queries or verifications, expedite processes and ensure clinician status changes are updated in an appropriate, timely fashion
• Performs other duties as assigned
• Accesses only the minimum necessary protected health information (PHI) for the performance of job duties. Actively protects the confidentiality and privacy of all protected health information they access in all its forms (written, verbal, and electronic, etc.) taking reasonable precautions to prohibit unauthorized access. Complies with all Atrius Health and departmental privacy policies, procedures and protocols. Follows HIPAA privacy guidelines without deviation when handling protected health information

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