Senior Provider Enrollment Representative - National Remote

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 start Caring. Connecting. Growing together. 

The Senior Credentialing Representative is responsible for activities associated with credentialing or re-credentialing physicians and providers, including processing provider applications and re-applications, and assisting with various research projects for initial credentialing, recredentialing, interim verifications, and ongoing monitoring to accurately manage and reconcile inventory in compliance with our regulatory standards and timelines.

Positions in this function are responsible for processing provider applications and re-applications, and this position also processes further review files for the Credentialing Committee, conducts audits and provides feedback to reduce errors and improve processes and performance, and reviews files to ensure criteria is met. Also responsible for process documentation, team communication, and continuous improvement.

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

Schedule:  Standard shift between the hours of 7:30am - 5:30 pm CST/EST 

Primary 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
• Demonstrate great depth of knowledge/skills in own function and act as a technical resource to others
• Solve complex problems on own; proactively identify new solutions to problems
• Act as a facilitator to resolve conflicts on team
• Perform as key team member on project teams spanning more than own function
• 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

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 (or higher)
• 2 years of experience in submitting behavioral health provider enrollment applications to at least 5 different payers (i.e. BCBS, Molina, Wellcare, Buckeye, TriCare, Medicare, Medicaid, etc.)
• Advanced level of proficiency in researching, understanding and complying with payer requirements
• Intermediate level of proficiency in managing correspondence and performing directory verifications
• Intermediate level of proficiency with MS Excel and Word

Preferred Qualifications:

• Experience with behavioral health payer enrollment with government payers in multiple states (Medicare and Medicaid)
• Experience using MD-Staff, PECOS and Availity
• Experience performing audits to identify and correct defects and aid in process improvement to prevent future defects
• Experience training, coaching or mentoring
• Advanced level of organizational skills
• Comfortable in a fast-paced environment with shifting tasks and responsibilities

Soft Skills: 

• Effective time management and ability to multi-task and shift assignments and priorities based on business need and risk
• Demonstrated ability to successfully work in a production environment and meet individual goals and metrics
• Keen attention to detail
• Self-starter
• Ability to work independently and as a team 

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

The salary range for this role is $19.86 to $38.85 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives. 

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.

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.

#RPO #GREEN

Salary : $20 - $39