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Senior Credentialing Representative, Intake

Company: UnitedHealth Group
Location: Philadelphia
Posted on: March 19, 2023

Job Description:

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.Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities andyour lifes best work.SM TheSr. Credentialing Representative Intakeis responsible for management of intake credentialing and status changes of Optum Care Services Allied Health Professional and Physician providers in 50 states and the US Virgin Islands. Intake functions include, but are not limited to, making phone calls to new hires, understanding of National Committee for Quality Assurance (NCQA) standards, Center for Medicare & Medicaid Services (CMS) guidelines, as well as federal and state regulations and requirements, regular participation with internal and external audits, preparation of credentialingfiles, liaison with Onboarding Department, and act as the backup representative for the PSV and Enrollment Representatives. Youll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities:

  • Accountability for the management of incoming Credentialing Request Forms (CRF)
  • Phone and email screen Advance Practice Clinicians for credentialing eligibility with professionalism
  • Issue new advanced practice clinicians Optum Credentialing Applications or CAQH information via email
  • Register Advanced Practice Clinicians with Council for Affordable Healthcare (CAQH)
  • Download completed applications from CAQH for states with State Mandated applications
  • Recognition of various credentialing documents: i.e., license, board certification, DEA
  • Receive all incoming initial credentialing applications; perform a preliminary review for completion; capture
  • supporting enrollment documents
  • Facilitation of Status Change Requests to the appropriate PSV or Enrollment Representative
  • Proficient data entry and maintenance into database in accordance with internal policies and procedures
  • Monitor and process State License, DEA/CDS, and Board Certificationexpirableson a continuous basis
  • Process provider termination notifications
  • Enroll and cancel continuous query requests with National Practitioner Databank (NPDB)
  • Generate and distribute Excel reports on a weekly and monthly basis
  • Develop and maintain relationships with market leadership of all levels
  • Anticipate customer needs and proactively identify solutions
  • Independently and as a team solve complex problems
  • Prioritize work tasks independently and utilize resources
  • Perform audits as requested from market leaders
  • Ability to work independently and with a team under minimal supervision
  • Ability to adapt well in a fast paced, changing environment
    Daily Practices:
    • Communicate professionally through email and over a telephone, to include receiving and making calls to clinicians
      Youll 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) OR 3+ years of credentialing experience
      • 1+ years of experience in a paperless office environment
      • 6+ months of experience with Adobe Acrobat Pro merge files and edit content
      • 6+ months ofexperience with conducting webbased research
      • 6+ months ofexperience with credentialing documentation in a healthcare setting
      • Intermediate level of proficiency in MS Programs:
        • Excel sort, filter, import / export data, basic formulas
        • Word create and modify docs, mail merge
        • Outlook manage incoming and outgoing emails, tasks, and calendars

          Preferred Qualifications:
          • Experience with any of the following: CAQH, PECOS, NCQA Standards related to credentialing, provider enrollment, CMS Regulations related to credentialing/enrollment, MDStaff, or credentialing software
          • Experience with Crystal Reports, SSRS Reports
          • Certification CPCS, CPMSM
          • Experienced in a healthcare office; healthcare language/acronyms
            Careers with Optum.Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges. *All Telecommuters will be required to adhere to UnitedHealth Groups Telecommuter Policy. California, Colorado, Connecticut, Nevada, New York, Washington or Rhode Island Residents Only:The hourly range for California, Colorado, Connecticut, Nevada, Washington or New York City residents is $18.80 to $36.78.Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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, youll find a far-reaching choice of benefits and incentives. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyoneof every race, gender, sexuality, age, location and incomedeserves 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

Keywords: UnitedHealth Group, Philadelphia , Senior Credentialing Representative, Intake, Other , Philadelphia, Pennsylvania

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