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Sr. Credentialing Representative of Enrollment job at UnitedHealth Group, Miami

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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 Sr. Credentialing Representative of Enrollment is a part of a team who is responsible for the oversight of enrollment and revalidation enrollment of OptumCare Allied Health Professional and Physician providers in 50 states and the US Virgin Islands. Enrollment functions include, but are not limited to, understanding of Center for Medicare Services (CMS) guidelines, Federal and State regulations & requirements, regularly participate with internal and external audits, understanding and operation of Council for Affordable Quality Healthcare (CAQH) ProView Portal, Provider Enrollment

Chain and Ownership System (PECOS), collaborate with practitioners to prepare paper and electronic applications for submission to Medicare/Medicaid and various commercial & government payers expeditiously, maintain delegated health plan rosters on set schedule, setup/maintain group enrollments, setup/maintain group NPI’s, maintenance of practice locations, and maintenance of Tax ID’s. Proficient in performing job functions with minimal tutoring.

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

Primary Responsibilities:

  • Generate, complete, and submit applications for new and established enrollments with Medicare (PECOS),
  • Medicaid, and various other Commercial/Government Health Plans
  • Meticulously review documents prior to transmission of applications via UPS/online and/or email to providers and
  • health plans
  • Data entry and maintenance into database in accordance with internal policies and procedures with high‐level
  • accuracy
  • Process verification of State License and Prescriptive Authority Expirables prior to expiration monthly
  • Maintain assigned, and backup assigned, regions in all aspects of provider enrollment
  • Apply knowledge/skills to complex activities
  • Provide feedback to reduce errors and improve processes
  • Develop and maintain relationships with market leadership
  • Anticipate customer needs and proactively identify solutions
  • Independently and as a team solve complex problems
  • Prioritize work tasks independently
  • Participate with internal and external audits
  • Provide exceptional customer service to our internal and external contacts
  • Ability to work independently in a remote location with minimal supervision
  • Adapt well in a changing environment

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
  • 3 years’ experience of Provider Enrollment Processes within a healthcare setting
  • 2 years’ experience with PECOS
  • 1 years’ experience with CAQH

Preferred Qualifications:

  • Experience with: PECOS, CMS Regulations related to enrollment, and conducting web‐based research
  • Be able to use:
    • Excel – sort, filter, import / export data, basic formulas
    • Word – create and modify docs, mail merge
    • Outlook – manage emails and calendars
    • Adobe Acrobat Pro – merge files and edit content
  • CPCS Certification

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.

Job Keywords: Remote, Nationwide, Work from home, Work at home, WFH, WAH, credentialing, rep, #RPO


Job country: United States

City: Miami

Category: Business Operations Specialists, All Other

Location: Miami, FL, United States

Job posted 2022-06-04

This job is expired

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