Remote Credentialing Specialist

Optum; El Segundo (CA); On-site; USD 25,000 - 44,000; Full time

Job summary

Optum is seeking a Credentialing Representative to support provider credentialing across markets in a remote, nationwide capacity. You will manage end-to-end data entry, file preparation, and system loading to ensure accuracy and compliance.

In a fast-paced, performance-driven environment, you will conduct audits, apply NCQA, CMS, and state requirements, and contribute to process improvements while collaborating with cross-functional teams.

Qualifications

• High School Diploma or GED is required.
• 3+ years of healthcare provider credentialing experience.
• 1+ years of experience working with compliance workflows and NCQA policies and practices.
• 1+ years of experience in researching and applying government regulatory information.
• Intermediate level of proficiency with MS Excel and Word.

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.
• Apply knowledge/skills to a range of moderately complex activities.
• Demonstrate depth of knowledge/skills in own function and act as a technical resource to others.
• Adhere to very exacting standards such as NCQA, CMS and State credentialing requirements.

Skills

Credentialing experience

Compliance workflows

Regulatory information research

Education

High School Diploma/GED

Tools

MS Excel

MS Word

Job description

Optum is seeking a Credentialing Representative to support provider credentialing across markets in a remote, nationwide capacity. You will manage end-to-end data entry, file preparation, and system loading to ensure accuracy and compliance.

In a fast-paced, performance-driven environment, you will conduct audits, apply NCQA, CMS, and state requirements, and contribute to process improvements while collaborating with cross-functional teams.