Senior Credentialing Representative

UnitedHealth Group•Eden Prairie, MN

2h•$20 - $36•Remote

About The Position

The Senior Credentialing Representative supports provider credentialing across multiple markets by managing end-to-end data entry, provider file preparation and system loading within MD Staff and related credentialing platforms. The position conducts audits, identifying process improvements and independently resolving complex issues. The role plays a critical part in ensuring accurate, compliant credentialing operations. 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
4+ years of healthcare provider credentialing experience
2+ years of experience working with compliance workflows and processes, including NCQA policies and practices
2+ years of experience researching and applying payer and government regulatory requirements
Intermediate level of proficiency with MS Excel and Word

Nice To Haves

MD Staff software experience
Proven ability to manage high-volume workloads, prioritize effectively, and meet tight deadlines
Experience partnering with Revenue Cycle Management (RCM) or resolving enrollment-related billing issues

Responsibilities

Manage end-to-end provider enrollment workflows, including roster submissions, individual enrollments, and revalidations across multiple payers
Maintain and update provider data across systems including MD-Staff, roster templates, and payer platforms, ensuring consistency and accuracy
Proactively track and follow up on enrollment statuses, resolving delays and preventing gaps that impact billing or network participation
Serve as a subject matter expert on payer-specific requirements, identifying nuances and adapting processes accordingly
Partner closely with RCM to investigate and resolve claim denials, reimbursement delays, and enrollment-related billing issues
Conduct audits, identify root causes of errors, and support process improvements to enhance accuracy and efficiency
Manage high-volume workloads and competing priorities, ensuring deadlines are consistently met without sacrificing quality
Operate effectively in an evolving environment where processes and job aids change; demonstrate the ability to bring structure and clarity
Act as a go-to resource for complex work while supporting overall team performance and success
Take ownership of issues from identification through resolution, including cross-functional coordination when needed
Support process improvement efforts by contributing to projects and helping refine existing workflows and team processes