Senior Credentialing Representative - Quality Auditor

UnitedHealth Group•Minneapolis, MN

18h•Remote

About The Position

The Senior Credentialing Representative is responsible for ensuring that credentialing information and data meets internal and external quality standards and requirements. Internal audits are performed against established standards for all credentialing and recredentialing functions within the Credentialing Center of Excellence (CCoE). The SCRA will document findings, identify trends, and recommend opportunities for improvement.

Requirements

Demonstrated understanding credentialing information processes
Established knowledge of credentialing requirements to include NCQA, CMS, and state-specific regulations
Attention to detail, ability to identify inconsistencies and missing information
Consistently delivers excellent quality of credentialing files processed
Analytical and critical thinking skills
Ability to research and evaluate credentialing criteria when questions or discrepancies are presented
Strong communication skills, ability to communicate clearly and professionally in written or oral formats
Ability to identify problems, analyze data and recommend solutions
Ability to maintain confidential information in accordance with Company policies, state, and federal regulations
Ability to manage detail and work with accuracy
Ability to acquire knowledge of technical resources within the organization
Ability to work independently
Ability to establish and maintain cooperative working relationships with individuals at all levels including teammates from other teams
Ability to work with frequent interruptions
Ability to prioritize work and skill in working effectively under deadlines and changing priorities
Demonstrated knowledge of Microsoft Office applications such as Word, Excel, and Outlook
Intermediate level skills working in Microsoft Excel
Consistently delivers excellent quality of work
High School Diploma/GED (or higher)
2+ years of experience in credentialing
1+ years of proven consistent quality audit scores passing or exceeding requirements
1+ years of experience using credentialing software or software managing provider information

Nice To Haves

Experience using MD-Staff credentialing software

Responsibilities

Performs daily audits of credentialing and recredentialing files utilizing standardized audit template
Ensures audits are performed within established timeframes
Communicates identified errors to credentialing representatives and specialists utilizing established processes
Participates in audit result review and track and trend of results
Participates in root cause analysis
Reviews repeat errors for potential training opportunities
Provides explanations and interpretations within area of expertise
Identifies potential process improvement needs to workflows and procedures
Communicates potential and identified trends to leadership
Collect and review credentialing files and materials for submission to delegating health plans at time of initial and annual delegation oversight audits
Collect and review submitted sub-delegated files and materials at time of pre-assessment and annual delegation oversight audits
Other department duties as assigned