Remote Credentialing & 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 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.