Here, your performance, your ideas, your unique analysis will combine with a rich assortment of contributors to understand and shape the health care system. At UnitedHealth Group, you'll work with a team that has the creativity and passion to help build new health care solutions that meet emerging market needs. You'll get the opportunity to work with an elite team that goes beyond the usual analysis, they dig deeper knowing our goal is nothing short of transforming health care. Does the challenge of utilizing your analytical abilities on vital projects towards a larger strategic mission excite you? Massachusetts LTSS (Long Term Services & Supports) providers provide services such as home health care services, adult day health and durable medical equipment for individuals with physical, intellectual or developmental disabilities, or who need support with activities of daily living. We are serving as the state's Third Party Administrator (TPA), providing clinical, administrative, operations and systems support for a program with $3.5 billion in annual spend. As a Senior Credentialing Analyst, you'll have the opportunity to provide data analysis to support, compile and report key information for operations and business objectives. This is a position that affords you the ability to drive processes and improvement initiatives. By gathering and documenting business requirements and utilizing your sharp analytical skills to fulfill the needs of the business and/or clients, you will have an impact on healing the health care system. This is a challenging role that creates an opportunity to grow and develop while doing your life's best work.(sm) Primary Responsibilities:Process Massachusetts LTSS Provider Medicaid applications, revalidations, and profile updatesPerform verbal, written and on-line primary source verification for individual and organizational providers, including but not limited to, state licensure, controlled substance registrations, accreditation status and exclusion database checksAccurately perform data entry of all primary source verifications and select provider demographic and practice location information into Optum's Long Term Services & Supports Management System (LTMS) & MassHealth's MMIS SystemMonitor work queue to ensure enrollments are processed within expected turnaround timesMeet or exceed production and quality standards. Perform unscheduled LTSS Provider site visits to verify compliance with regulations (60% local travel).Monitor work queue to ensure enrollments are processed within expected turnaround times.Gather and document business requirements from client. Create standard operating procedures (SOPs) and training documentation to support enrollment, revalidation, and update processing
Required Qualifications:Bachelor's degree in Business, Finance, Health Administration, related field or equivalent work experience3+ years of experience in analysis of business processes and workflow and providing process improvement recommendationsDetail-oriented, analytical, highly organized and possessing problem-solving skillsExperience gathering requirements from clients Experience creating standard operating procedures (SOPs) and training documentationIntermediate level of proficiency with PC based software programs (Excel, PowerPoint, Word, and Visio)Ability to communicate analysis including trends and opportunities to clients and the business in writing and verballyAbility to problem solve including multiple priorities and research conflicting and/or inaccurate dataAbility to present complex data clearly and concisely to external clients Preferred Qualifications:Salesforce experienceEnrollment and credentialing experienceExperience working with and communicating with providers 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.
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.