Senior Credentialing Representative

Optum; Eden Prairie (MN); Remote; USD 42,000 - 75,000; Full time

Benefits offered by this job

Paid Time Off

Medical Plan options

Dental, Vision

Job summary

Optum is seeking a Senior Credentialing Representative to enroll behavioral health providers with payers and manage primary source verifications. The role offers a remote, nationwide work setup with a structured schedule and opportunities to influence credentialing processes.

Candidates should have 3+ years in healthcare credentialing and strong Excel/Word skills. The position requires attention to HIPAA guidelines and the ability to work independently in a fast-paced environment.

Qualifications

• Minimum of 3+ years in healthcare customer service and/or administration.
• Minimum of 3+ years of healthcare provider credentialing experience.
• Advanced proficiency with Microsoft Excel and Word.

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 and performance.
• Demonstrate problem-solving and independently resolve complex issues related to credentialing.

Skills

Customer service

Credentialing knowledge

Attention to detail

Education

High School Diploma/GED

Tools

Microsoft Excel

Microsoft Word

Job description

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

Job Description - Senior Credentialing Representative (2387745)

Senior Credentialing Representative - 2387745

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 Senior Credential Representative. Senior 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
• Help develop credentialing policies and procedures and, oversee primary source verification activities
• Investigate non-standard requests and problems
• Leverages subject matter expertise to support and advise team members on functional processes and best practices.
• Takes initiative in evaluating complex requests, recommending solutions, and resolving issues independently.
• Facilitates onboarding and training for new employees and delivers targeted coaching and retraining for team members requiring additional support or development.
• 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
• 3 + years of healthcare customer service and/or administration experience
• 3 + years of healthcare provider credentialing experience
• Advanced 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 providersand 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 $20.00 to $36.00 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.