Senior Enrollment and Credentialing Specialist - New England - Remote

UnitedHealth Group•Nashua, NH

6d•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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. Position Summary: The Senior Enrollment and Credentialing Specialist is responsible for overseeing and executing the full cycle of provider enrollment, credentialing, and re-credentialing processes for long-term services and healthcare providers. This role ensures compliance with regulatory, accreditation, and payer requirements while maintaining accurate provider records and facilitating timely participation in insurance networks. The Senior Specialist serves as a subject matter expert, mentors’ junior staff, and partners with leadership optimize workflows, reduce turnaround times, and support organizational growth. If you are located in reside within New England or NYS - NH, RI, CT, NYS, you will have the flexibility to work remotely as you take on some tough challenges. You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Requirements

2+ years of progressive experience in provider enrollment, credentialing, or payer relations, preferably in long-term services or post-acute care
2+ years of experience with Medicare, Medicaid, and commercial payer enrollment processes.
1+ years of experience in credentialing software
1+ years of experience with Excel: ability to do formulas, V look ups and pivot tables
Proficiency with Microsoft Office Suite
Proven exceptional organizational skills with the ability to manage multiple priorities and meet deadlines.
Proven solid interpersonal, communication, and problem-solving skills.
Proven detail-oriented with a high level of accuracy and accountability.
Willingness to travel up to 25%25 per month for site visits

Nice To Haves

Experience with MMIS, PECOS, and payer portals
Experience mentoring or leading a credentialing team

Responsibilities

Manage the complete enrollment and credentialing process for physicians, nurse practitioners, and other long-term care providers across multiple payers and networks
Track application status, follow up with payers, and resolve issues to ensure timely provider participation
Coordinate initial credentialing, re-credentialing, and ongoing monitoring in compliance with CMS, and state requirements
Manage continuous credentialling and maintain accurate and up-to-date provider files, licenses, certifications, and attestations
Assign applications to team members, monitor status and help resolve issues
Ensure provider records meet federal, state, payer, and organizational standards
Conduct audits of provider files and enrollment documentation to identify gaps and ensure accuracy
Monitor expirable (licenses, DEA, board certifications, liability insurance) and coordinate timely renewals
Stay current on changes in payer regulations, credentialing standards, and industry best practices
Serve as a primary contact between providers, internal departments, and payer representatives
Educate providers and staff on credentialing requirements, timelines, and documentation standards
Work closely with compliance, legal, and operations teams to mitigate risks related to provider credentialing and enrollment
Mentor and support junior credentialing specialists, providing training and guidance
Recommend and implement process improvements to enhance efficiency and reduce enrollment turnaround time
Assist leadership in developing policies, procedures, and reporting metrics related to enrollment and credentialing