Credentialing and Enrollment Specialist

Optum; Las Vegas (NV); On-site; USD 40,000 - 72,000; Full time

Job summary

Optum is seeking a Credentialing and Enrollment Specialist to support provider credentialing across the United States. This full-time remote role offers standard business hours and the opportunity to contribute to national credentialing activities.

You will perform primary source verification, coordinate with Medical Director and auditors, and ensure adherence to TJC, NCQA, CAQH, and CMS standards while maintaining licensure records and collaborating with internal teams.

Qualifications

• 3+ years of healthcare provider group/facility credentialing experience.
• 2+ years of healthcare administration, medical staff services, health information management.
• 2+ years of credentialing processes, medical staff privileging, and related software/databases.
• Proficiency with Microsoft Excel and Word.
• Ability to work Pacific time zone hours.

Responsibilities

• Apply knowledge to a range of moderately complex credentialing activities.
• Meet with Medical Director to review initial and reappointment applications.
• Coordinate with AAAHC and State Auditors to review files.
• Perform Primary Source Verification for initial and reappointments.
• Maintain expirables for clinicians at ASCs.
• Prepare Credentialing Committee Minutes.
• Audit credentialing and re-credentialing files for accuracy and compliance.
• Monitor renewal dates and advise medical staff on steps to maintain credentials.
• Identify solutions to non-standard requests.
• Present to group settings and coordinate team work.

Skills

Healthcare credentialing

Healthcare administration

Credentialing processes

Time management

Pacific time availability

Education

Healthcare administration experience

Tools

Microsoft Excel

Microsoft Word

Job description

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.

Credentialing and Enrollment Specialist

Location

Remote Nationwide

Schedule

FT, 40 hrs. Monday - Friday, 8am - 5pm

You’ll enjoy the flexibility to work remote* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities

• Apply knowledge/skills to a range of moderately complex activities
• Demonstrate great depth of knowledge/skills in own function
• Sometimes act as a technical resource to others in own function
• Meet with Medical Director to review initial and reappointment applications
• Meet with AAAHC and State Auditors to review files
• Primary Source Verification Process for initial and reappointments
• Maintain Expirables for all employed and non employed clinicians at ASCs
• Compile and generate Credentialing Committee Minutes
• Perform internal audits on credentialing and re-credentialing files for accuracy and maintaining compliance with credentialing policies and procedures
• Maintaining knowledge of and compliance with TJC, NCQA, CAQH, and CMS standards, as appropriate
• Monitoring upcoming renewal dates and working with medical staff to advise them on steps to maintain their credentials
• Proactively identify solutions to non-standard requests
• Solve moderately complex problems on own
• Work with team to solve complex problems
• Presentation skills to group setting
• Plan, prioritize, organize and complete work to meet established objectives
• May coordinate work of other team members
• Credentialing of medical group providers and hospital privileging application review and submission at the individual and group level
• Complete revalidation requests with govt and commercial payers
• Track and maintain medical professionals' licensure, certifications, etc.
• Work with other organizational departments internal/external to sure that credentialing efforts are in line with business objectives

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.

Required Qualifications

• 3+ years of Healthcare Provider group/Facility Credentialing experience
• 2+ years of experience in healthcare administration, medical staff services, health information management
• 2+ years of experience with credentialing processes, medical staff privileging and knowledge of relevant software or databases used in credentialing
• Intermediate level of proficiency with Microsoft Excel and Word
• Ability to work Pacific time zone hours

Preferred Qualifications

• Experience working with Compliance Workflows and Processes including AAAHC, JC, CMS, and NCQA Policies
• Experience in researching and applying Government Regulatory Information
• Knowledge of CAQH
• Knowledge of MDStaff credentialing data base
• Data analytics
• Pecos enrollment
• Proven ability to plan and prioritize to meet benchmarks/deadlines
• All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $29.00 to $52.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

Application Deadline

This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

#RPO, #GREEN