Credentialing Representative

Optum; La Crosse (WI); Remote; USD 25,000 - 44,000; Full time

Benefits offered by this job

Paid Time Off + 8 holidays

Medical, Dental, Vision, Life & AD&D

401(k) + Employee Stock Purchase Plan

Education Reimbursement

Employee Discounts

Employee Assistance Program

Employee Referral Bonus Program

Voluntary Benefits (pet insurance, etc

Job summary

Optum is seeking a Credentialing Representative - National Remote to enroll behavioral health providers with payers, maintaining practitioner records, and ensuring compliance across credentialing cycles. You will document requirements, verify applications, and coordinate with internal teams to support a smooth credentialing process.

The role requires a HS diploma or GED and 1+ year credentialing/healthcare experience, plus proficiency in MS Excel/Word and strong communication.

Qualifications

• High School Diploma or GED required.
• 1+ years of credentialing and/or healthcare experience.
• Proficiency with MS Excel and Word.

Responsibilities

• Identify credentialing requirements and document them in practitioner records.
• Initiate credentialing processes and verify applications with supporting documents.
• Perform quality reviews and monitor re-credentialing on a 3-year cycle.
• Act as liaison between practitioner network and internal teams to resolve issues.

Skills

Independent work

Team collaboration

Customer service

Education

High School Diploma/GED

Tools

MS Excel

MS Word

Job description

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

Job Description - Credentialing Representative (2326548)

Credentialing Representative - 2326548

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 aCredential Representative - National Remote.Credential Representative - National Remotewill be responsible for enrolling behavioral health providers with appropriate payers for associated entities.

Schedule:

Monday - Friday, 8:00AM - 5:00PMcentral standard time

Primary Responsibilities:

• Identify and document credentialing, compliance and contract requirements as they enroll in Optum Serve’s network, including the creation and maintenance of practitioner records within databases
• Initiate credentialing processes, retrieve, verify/ follow up on all credentialing applications and supporting documentation needed for Optum Serve’s practitioner network. Ensure credentialing applications are complete, data integrity is intact within databases to meet requirements for primary source verification and industry standards
• Perform quality reviews on credentialing files throughout each credentialing cycle
• Monitor and facilitate complete and accurate re-credentialing of practitioners on a 3-year cycle
• Act as the liaison between the practitioner network and internal departments to troubleshoot issues or answer any questions/concerns
• Ongoing monitoring of credentialed network for accuracy or any change in status to include regular internal practitioner record audits
• Submit appropriate practitioner records to CVO (Certified Verification Organization) or other credentialing vendor, if applicable. Retrieve and review CVO or other credentialing vendor files as completed, if applicable
• Submit background checks as required on credentialed practitioners to contracted vendors. Retrieve and review the completed background check reports as part of the credentialing packet
• 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 directions 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 experience in credentialing and/or healthcare
• 1 + years of computer proficiency with MS Excel and Word
• Ability to work a 40-hour week between 8:00 am to 5:00 pm Central Standard time
• Ability to remain engaged in a phone-based support queue for the entirety of the workday, ensuring timely customer service and issue resolution
• 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:

• Healthcare terminology experience
• Certified Provider Credentialing Specialist (CPCS) through the National Association Medical Staff Services
• National Career Readiness Certificate
• Familiarity with NCQA credentialing standards. Knowledge of practitioner credentialing and primary source verification of medical/dental licensure

Soft Skills:

• Ability to work independently and as a team, and maintain good judgment and accountability
• Demonstrated ability to work well with health care providersand team members
• Strong organizational and time management skills
• Ability to 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 - $32 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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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.