Position Description:Energizeyour career with one of Healthcare's fastest growing companies. Youdream of a great career with a great company – where you can make an impact andhelp people. We dream of giving you theopportunity to do just this. And withthe incredible growth of our business, it's a dream that definitely can cometrue. Already one of the world's leading Healthcare companies, UnitedHealthGroup is restlessly pursuing new ways to operate our service centers, improveour service levels and help people lead healthier lives. We live for the opportunity to make adifference and right now, we are living it up. Thisopportunity is with one of our most exciting business areas: Optum –a growingpart of our family of companies that make UnitedHealth Group a Fortune 17 leader. Optum helps nearly 60million Americans live their lives to the fullest by educating them about theirsymptoms, conditions and treatments; helping them to navigate the system,finance their healthcare needs and stay on track with their health goals. Noother business touches so many lives in such a positive way. And we do it allwith every action focused on our shared values of Integrity, Compassion,Relationships, Innovation & Performance.Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.(sm)The Senior Credentialing Representative is responsible for oversight of internal credentialing and recredentialing of OptumCare Allied Health Professional and Physician providers in 42 states.Credentialing functions include, but are not limited to, understanding of National Committee for Quality Assurance (NCQA) standards, Center for Medicare Services (CMS) guidelines, as well as federal and state regulations and requirements, regularly participate with internal and external audits, prepare files and attend credentialing committee meetings. Primary Responsibilities:Intake application reviewProcessing Credentialing Request Forms (CRF)Process credentialing applicationsPerforming primary source verifications (PSV)Data entry and maintenance into Access Database in accordance with internal policies andproceduresCommunicate with committee membersProvide feedback to reduce errors and improve processesMonitor and process expiriables on an ongoing basisDevelop and maintain relationships with market leadershipAnticipate customer needs and proactively identify solutionsIndependently and as a team solve complex problemsPrioritize work tasksParticipate in auditsOther duties as assigned
Required Qualifications:High School Diploma / GED (or higher)1+ years of experience of Medical Credentialing processesExperience with NCQA Standards related to credentialingExperience with CMS Regulations related to credentialingExperience with CAQH ProViewProficient computer skills in Microsoft Office including Microsoft Excel (manipulating data and spreadsheets), Microsoft Word, Microsoft Outlook, Microsoft Access, and AdobePreferred Qualifications:CPCS or CPMSM CertificationProvider Enrollment understanding or experienceCareers with Optum. Here's the idea. We built an entire organizationaround one giant objective; make the health system work better for everyone. Sowhen it comes to how we use the world's large accumulation of health-relatedinformation, or guide health and lifestyle choices or manage pharmacy benefitsfor millions, our first goal is to leap beyond the status quo and uncover newways to serve. Optum, part of the UnitedHealth Group family of businesses,brings together some of the greatest minds and most advanced ideas on wherehealth care has to go in order to reach its fullest potential. For you, thatmeans working on high performance teams against sophisticated challenges thatmatter. Optum, incredible ideas in one incredible company and a singularopportunity to do your life's best work.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.Keywords: UnitedHealth Group; Senior Credentialing Representative; Franklin, TN
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.