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Senior Credentialing Representative PSV job at UnitedHealth Group, Houston

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Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

The Senior Credentialing Representative PSV is responsible for oversight of credentialing and recredentialing of OptumCare Allied Health Professional and Physician providers in 50 states and the US Virgin Islands. 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 credentialing application review for completion and supporting documentation

  • Process name and address changes

  • Process initial credentialing and recredentialing applications following policy and procedures

  • Process status changes following policy and procedures

  • Perform primary source verifications (PSV) from various online sources according to the definition of primary source

  • Assist practitioners with CAQH updates and re‐attestations

  • Data entry and maintenance into credentialing database in accordance with internal policies and procedures

  • Communicate with Credentialing Committee Members, Credentialing Chair, and Chief Medical Officer (CMO)

  • Participate with Credentialing Committee Meetings and support each file presented

  • Prepare the minutes for each file presented at the Credentialing Committee Meeting

  • Provide feedback to reduce errors and improve processes

  • Monitor professional licensures, DEA Registrations, CDS, Prescriptive Authority, Board Certifications, etc. for expiration and sanctions on an ongoing basis

  • Provide continuous monitoring of OIG/SAM/NPDB sanctions

  • Support Provider Enrollment team efforts

  • Develop and maintain relationships with market leadership of various levels

  • Anticipate customer needs and proactively identify solutions

  • Independently and as a team solve complex problems

  • Mentor Credentialing Representatives to grow into the Senior roles

  • Be able to act without direct supervision in a virtual, fast‐paced environment

  • Undergo delegation and internal audits

  • Other duties as assigned

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 or GED

  • 2+ years’ experience of allied health and/or medical credentialing processes

  • 1+ year experience with NCQA Standards relating to credentialing

  • Intermediate Proficient computer skills to include MS Office, MS Excel, MS Word, MS Outlook, Adobe Pro, MS Access

Preferred Qualifications:

  • CPCS or CPMSM Certification by NAMSS

  • Experience with CAQH ProView

  • Provider Enrollment understanding or experience

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

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

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $18.17 to $32.26. The salary range for Connecticut / Nevada residents is $20.00 to $35.53. 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, you’ll find a far-reaching choice of benefits and incentives 

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: #RPO, wfh, wah, remote

Job country: United States

City: Houston

Category: Business Operations Specialists, All Other

Location: Houston, TX, United States

Job posted 2022-06-04

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