Senior Credentialing Representative

2 hours ago

Owensboro, Kentucky, United States Optum Full time

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale.Join us to start Caring. Connecting. Growing together.

Based on the role's needs, the anticipated schedule for this role is approximately 8:00am-4:30pm Central Time Zone, regardless of state of residence.

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

Primary Responsibilities:

  • Gathers required information and documents from providers to appropriately enroll them with our contracted payers
  • Submits onboarding validation form to ensure providers are built appropriately in our Epic billing system so claims are accurate
  • Completes payer enrollment applications for newly onboarded providers and/or add locations for existing providers
  • Performs tracking and follow-up on payer enrollment applications to ensure providers are linked appropriately with the payer; and updates MDStaff and Marketware software applications
  • Participates and provides consistent updates to onboarding team and clinic leaders to ensure timelines are met to complete the credentialing process with our payers
  • Communicates effective dates and payer updates to billing and clinic leaders to ensure claims are billed appropriately
  • Manages each provider's Council for Affordable Quality Healthcare (CAQH) and National Provider Identifier (NPI) accounts
  • Establishes close working relationships with providers, clinic leaders, billing leaders, managed care, and payer contacts
  • Pulls reports from MDstaff as needed for various departments and to verify completion of payer enrollments
  • Identifies and reviews credentialing alerts with clinic leaders
  • Maintains and ensures provider licensure, certificate of insurance, and network expirations
  • Submits re-validations and re-credentialing to Medicare and Medicaid, and other contracted networks
  • Assists providers and clinic leaders in a thorough understanding of the credentialing/enrollment processes and policies

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 (or higher)
  • Intermediate level of proficiency with MS Excel and Word
  • Willingness to work an approximate shift from 8:00am to 4:30pm Central, regardless of USA time zone residing in

Preferred Qualifications:

  • 4+ years of healthcare provider payer enrollment credentialing experience
  • 2+ years of experience working with compliance workflows and processes, including Joint Commission policies and practices
  • 2+ years of experience in researching and applying government regulatory information
  • Experience with MDstaff database software
  • Experience with Market Ware Software
  • Experience with Kentucky and Indiana payer enrollment credentialing experience
  • 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 $35.72 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.

RPO #GREEN

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