Credentialing Representative

Optum; Eden Prairie (MN); Remote; USD 25,000 - 44,000; Full time

Benefits offered by this job

Paid Time Off

Medical/Dental/Vision Insurance

401(k) & Employee Stock Purchase Plan

Education Reimbursement

Employee Discounts

Employee Assistance Program

Job summary

Optum is seeking a Credentialing Representative to enroll behavioral health providers with payers across entities. This role emphasizes accuracy and adherence to credentialing standards while supporting a fast-paced, performance-driven environment.

The position offers a Monday–Friday schedule with early morning hours and the option to telecommute from anywhere in the U.S., enabling flexible, location-independent work within a large health system.

Qualifications

• High School Diploma or GED required.
• 1+ years healthcare customer service and/or administration experience.
• 1+ years healthcare provider credentialing experience.
• Proficiency with Microsoft Excel and Word.
• Access to a designated quiet home workspace with PHI security and reliable internet.

Responsibilities

• Process provider applications and re-applications including initial communications, verifications, review and loading into databases.
• Conduct quality audits and provide feedback to reduce errors and improve processes.
• Solve complex problems and identify new solutions within credentialing workflows.
• Prioritize daily responsibilities and ensure compliance with NCQA, CMS, and state credentialing requirements.
• Performs other duties as assigned.

Skills

Healthcare customer service

Credentialing experience

Excel / Word proficiency

Education

High School Diploma/GED

Tools

Microsoft Office

Job description

Improve the lives of others while Caring. Connecting. Growing together.

Job Description - Credentialing Representative (2389388)

Credentialing Representative - 2389388

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 startCaring. Connecting. Growing together.

Optum has an immediate opening for a Credential Representative Credential Representative will be responsible for enrolling behavioral health providers with appropriate payers for associated entities.

Schedule:

Monday through Friday from 6:00AM - 6:00PMCST. The schedule will be determined by the supervisor upon hire.

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

Primary Responsibilities:

• Process provider applications and re - applications including initial communications, verifications, review and loading into the databases
• Conduct quality audits and provide feedback to reduce errors and improve processes and performance
• Solve complex problems on own; proactively identifying new solutions to problems
• Apply knowledge / skills to a range of moderately complex activities
• Demonstrate great depth of knowledge / skills in own function and function as an information resource to others
• Analytical skills for data analysis from multiple sources
• Ability to prioritize daily responsibilities
• 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
• Performs other duties as assigned

What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

• 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.)

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:

• High School Diploma/GED
• 1+ years of healthcare customer service and/or administration experience
• 1+ years of healthcare provider credentialing experience
• Intermediate level of proficiency with Microsoft Excel and Microsoft Word
• Access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information (PHI)
• Live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Preferred Qualifications:

• Experience working with compliance workflows and processes, including NCQA policies and practices
• Experience researching and applying government regulatory information

Soft Skills:

• Ability to work independently and as a team, and maintain good judgment and accountability
• Demonstrated ability to work well with health care providers and team members
• Strong organizational and time management skills
• Ability to multi-task and prioritize tasks to meet all deadlines
• Ability to work well under pressure in a fast-paced environment
• Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying information in a manner that others can understand, as well as ability to understand and interpret information from others

*All Telecommuters 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 $18.00 to $32.00 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.

UnitedHealth Group is committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need special assistance or accommodation for any part of the application process, please call 1-866-566-8715 to be connected to Recruitment Services. Recruitment Services hours of operation are 7 a.m. to 7 p.m. CT, Monday through Friday.

UnitedHealth Group is a registered service mark of UnitedHealth Group, Inc. The UnitedHealth Group name with the dimensional logo, as well as the dimensional logo alone, are both service marks for the UnitedHealth Group, Inc.

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.