Senior Provider Enrollment Representative

UnitedHealth Group • Eden Prairie, MN

122d • $19 - $38

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.

Requirements

• High School Diploma/GED (or higher)
• 5+ years of experience in submitting at least 10-15 behavioral health provider payer enrollment applications
• 5+ years of experience with submitting commercial/ government payer enrollment applications
• 5+ years of experience submitting enrollment applications that include at least 10 different payer enrollment
• 5+ years of experience submitting with follow ups and issue resolution from at least 10 different payer enrollment
• 2+ years of experience with Medicare/Medicaid
• 2+ years of experience working with compliance workflows and processes, including NCQA policies and practices
• 2+ years of experience in researching and applying government regulatory information
• Intermediate level of proficiency with MS Excel and Word
• Ability to work from 8:00 am to 5:00 pm EST

Nice To Haves

• Knowledge of payers such as Medicare, Medicare Railroad & Medicaid (CT, NC, NY, VA, RI), Aetna, Beacon/Carelon, BCBS (Multiple States), UHC Optum (UBH) Multiplan, Molina Healthcare, Alliance Health, TriCare East/Humana Military, Harvard Pilgrim, Tufts Healthcare, Quest BH, TriState, Zelis, Wellcare, Fidelis, Johns Hopkins/EHP, Care Partners, UPMC/CCBH, Amerihealth, Capital District Health Plan, MVP Health Care, PACE CNY, Vaya Health, Optima/Sentara Health Plans
• Knowledge of provider enrollment applications for the following states: Alabama, Florida, Maryland, New Hampshire, Massachusetts, Pennsylvania, Connecticut, North Carolina, Virginia, New York, New Jersey, Rhode Island, & Delaware

Responsibilities

• Help process provider applications and re-applications including initial mailing, review and loading into the database tracking system
• Conduct audits and provide feedback to reduce errors and improve processes and performance
• Demonstrate great depth of knowledge/skills in own function and act as a technical resource to others
• Solve complex problems on own; proactively identify new solutions to problems
• Act as a facilitator to resolve conflicts on team
• Perform as key team member on project teams spanning more than own function
• Get ready for some significant challenge. 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

Benefits

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life& AD&D Insurance along with Short-term disability 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 (pet insurance, legal insurance, LTC Insurance, etc.)

What This Job Offers

• Job Type: Full-time
• Industry: Insurance Carriers and Related Activities
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees