Senior Credentialing Representative

UnitedHealth Group • El Segundo, CA

111d • $20 - $35 • Remote

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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. The Senior Credentialing Representative position acts as an internal consultant to the organization, assisting in the development of analytic tools and reports, and providing credentialing database related support throughout Optum. Oversees and participates in the administrative aspects of credentialing services to meet medical group, plan to plan, health plan and National Committee for Quality Assurance (NCQA) requirements.

Requirements

• High School Diploma/GED (or higher)
• 1+ years of experience in credentialing or compliance
• Intermediate level of computer literacy in Windows environment with Access and Excel knowledge

Nice To Haves

• 1+ years of experience in credentialing or compliance in managed care
• Knowledge of various credentialing platforms are highly desirable - MD staff
• Knowledge of Practice Management Software and Vistar Software System

Responsibilities

• Design and complete data analysis projects for department customers including defining informational needs, appropriate methodologies and report formats.
• Provide written reports with accompanying documentation of findings.
• Conduct audits of the credentialing database, confirming accurate input of provider data, including auditing other staff data entry and verifying accuracy of modifications made to the database.
• Monitor security of data within the Credentialing Database with individuals to whom data or system access may be given, report infractions to the Credentialing Supervisor.
• Responsible for performing and/or supporting the onboarding and enrollment processes, as assigned.
• Maintain current knowledge of computer hardware and database software capabilities.
• Orient new staff to appropriate database use, capabilities, security, etc.
• Act as project leader and assist in the development of provider data reporting, as requested.
• Collaborate with Information Technology to review approved software installations, upgrades, incremental backups and restorations; assist in the development of configuration documentation and updates as necessary.
• Maintain appropriate logs of database-related problems and modifications; monitor database performance and space; investigate and resolve all departmental problems, questions and concerns, and make modifications, as necessary.
• Report on all systemic database issues to the Supervisor.
• Disseminate new/modified professional information to HMOs and to internal departments through the Information System Change Control Process.
• Process credentialing/recredentialing applications accurately and promptly in accordance with internal Optum policies and procedures and NCQA standards.
• Coordinate the credentialing and re-credentialing processes with the Quality Improvement Department and other internal departments, as necessary.
• Prepare materials and files necessary to comply with external audits by health plans or governmental agencies.
• Accepts and performs other duties and responsibility as assigned.

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Insurance Carriers and Related Activities
• Education Level: High school or GED