Senior Credentialing Representative

UnitedHealth Group•Owensboro, KY

3d•$20 - $36•Remote

About The Position

The Senior Credentialing Representative gathers provider information and documentation, completes payer enrollment applications, and tracks applications to ensure providers are correctly linked with contracted payers. The role also supports accurate provider setup in the Epic billing system and maintains credentialing and enrollment information in MDStaff and Marketware. This position coordinates with providers, clinic leaders, billing teams, managed care, payer contacts, and onboarding teams to meet credentialing timelines and communicate effective dates and payer updates. Responsibilities also include managing CAQH and NPI accounts, monitoring provider credentials and expirations, handling Medicare and Medicaid revalidations and re-credentialing, and helping providers and clinic leaders understand credentialing processes and policies. The role is telecommute-eligible from anywhere in the United States. The anticipated schedule is approximately 8:00 a.m. to 4:30 p.m. Central Time, regardless of the employee’s state of residence. The hourly pay range is $20.00 to $36.00 based on full-time employment.

Requirements

High school diploma or GED.
Intermediate proficiency with Microsoft Excel and Word.
Willingness to work approximately 8:00 a.m. to 4:30 p.m. Central Time, regardless of U.S. time zone of residence.

Nice To Haves

At least 4 years of healthcare provider payer enrollment credentialing experience.
At least 2 years of experience with compliance workflows and processes, including Joint Commission policies and practices.
At least 2 years of experience researching and applying government regulatory information.
Experience with MDStaff database software.
Experience with Market Ware software.
Experience with Kentucky and Indiana payer enrollment credentialing.

Responsibilities

Gather required information and documents from providers to enroll them with contracted payers.
Submit onboarding validation forms to ensure providers are set up correctly in the Epic billing system for accurate claims.
Complete payer enrollment applications for newly onboarded providers and add locations for existing providers.
Track and follow up on payer enrollment applications to ensure providers are appropriately linked with payers, and update MDStaff and Marketware applications.
Provide consistent updates to the onboarding team and clinic leaders to help meet credentialing timelines.
Communicate effective dates and payer updates to billing and clinic leaders to support accurate claims billing.
Manage provider CAQH and NPI accounts.
Build working relationships with providers, clinic leaders, billing leaders, managed care, and payer contacts.
Pull MDStaff reports for departments and to verify completion of payer enrollments.
Identify and review credentialing alerts with clinic leaders.
Maintain and monitor provider licensure, certificates of insurance, and network expiration dates.
Submit Medicare and Medicaid revalidations and re-credentialing, as well as submissions for other contracted networks.
Help providers and clinic leaders understand credentialing and enrollment processes and policies.

Benefits

Paid time off accrued beginning with the first pay period.
Eight paid holidays.
Medical plan options and participation in a Health Spending Account or Health Savings Account.
Dental, vision, life and AD&D insurance.
Short-term 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, including pet insurance, legal insurance, and long-term care insurance.
Performance rewards and incentive and recognition programs.
Equity stock purchase and 401(k) contribution, subject to eligibility requirements.