Credentialing Representative

Posted 14 Minutes Ago
Be an Early Applicant
Eden Prairie, MN, USA
In-Office
18-32 Hourly
Junior
Artificial Intelligence • Big Data • Healthtech • Information Technology • Machine Learning • Software • Analytics
The Role
Processes behavioral health provider credentialing applications and reapplications, including communications, verifications, database loading, quality audits, and compliance reviews. Ensures adherence to NCQA, CMS, and state requirements while analyzing data, resolving problems, improving processes, and prioritizing work in a fast-paced environment. The role requires collaboration with providers and team members, strong organization, accurate documentation, and independent judgment.
Summary Generated by Built In
Requisition Number: 2379538
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. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.
Optum has an immediate opening for a Credential Representative. Credential Representative will be responsible for enrolling behavioral health providers with appropriate payers for associated entities.
Schedule: Monday through Friday from 6:00AM - 6:00PMCST. The schedule will be determined by the supervisor upon hire.
You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
  • Process provider applications and re - applications including initial communications, verifications, review and loading into the databases
  • Conduct quality audits and provide feedback to reduce errors and improve processes and performance
  • Solve complex problems on own; proactively identifying new solutions to problems
  • Apply knowledge / skills to a range of moderately complex activities
  • Demonstrate great depth of knowledge / skills in own function and function as an information resource to others
  • Analytical skills for data analysis from multiple sources
  • Ability to prioritize daily responsibilities
  • Get ready for some significant challenge. This is a performance driven, fast paced environment where accuracy is key. You'll be helping us confirm to very exacting standards such as NCQA, CMS and state credentialing requirements
  • Performs other duties as assigned

What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:
  • Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
  • Medical Plan options along with participation in a Health Spending Account or a Health Saving account
  • Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
  • 401(k) Savings Plan, Employee Stock Purchase Plan
  • Education Reimbursement
  • Employee Discounts
  • Employee Assistance Program
  • Employee Referral Bonus Program
  • Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

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
  • 1+ years of healthcare customer service and/or administration experience
  • 1+ years of healthcare provider credentialing experience
  • Intermediate level of proficiency with Microsoft Excel and Microsoft Word
  • Access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information (PHI)
  • Live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Preferred Qualifications:
  • Experience working with compliance workflows and processes, including NCQA policies and practices
  • Experience researching and applying government regulatory information

Soft Skills:
  • Ability to work independently and as a team, and maintain good judgment and accountability
  • Demonstrated ability to work well with health care providers and team members
  • Strong organizational and time management skills
  • Ability to multi-task and prioritize tasks to meet all deadlines
  • Ability to work well under pressure in a fast-paced environment
  • Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying information in a manner that others can understand, as well as ability to understand and interpret information from others

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $18.00 to $32.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves 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.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
#RPO #GREEN

Skills Required

  • High School Diploma or GED
  • At least 1 year of healthcare customer service and/or administration experience
  • At least 1 year of healthcare provider credentialing experience
  • Intermediate proficiency with Microsoft Excel
  • Intermediate proficiency with Microsoft Word
  • Designated quiet home workspace capable of securing Protected Health Information
  • Access to UnitedHealth Group-approved high-speed internet or existing high-speed internet service
  • Experience with compliance workflows and processes, including NCQA policies and practices
  • Experience researching and applying government regulatory information
  • Ability to work independently and collaboratively with good judgment and accountability
  • Ability to work effectively with healthcare providers and team members
  • Strong organizational and time-management skills
  • Ability to multitask and prioritize deadlines
  • Ability to work under pressure in a fast-paced environment
  • Excellent verbal and written communication skills

What the Team is Saying

Optum Compensation & Benefits Highlights

  • Leave & Time Off Breadth — Paid time off is often regarded as generous, with meaningful accrual and flexibility to use it. While practices can vary by team, the overall time-off offering stands out as a relative strength.
  • Retirement Support — A 401(k) plan with employer matching is available and generally well-regarded for supporting long-term savings. It remains valuable, though candidates should verify the current match formula.
  • Parental & Family Support — Programs such as parental leave, family medical leave, and adoption assistance are included as notable elements of the total rewards package. These resources can meaningfully support work-life balance when applicable to the role and location.

Optum Insights

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The Company
HQ: Eden Prairie, MN
160,000 Employees
Year Founded: 2011

What We Do

Optum, part of the UnitedHealth Group family of businesses, 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. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. At Optum, we support your well-being with an understanding team, extensive benefits and rewarding opportunities. By joining us, you’ll have the resources to drive system transformation while we help you take care of your future. We recognize the power of connection to drive change, improve efficiency and make a difference in health care. Join a team where your skills and ideas can make an impact and where collaboration is key to creating technology that produces healthier outcomes.

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Optum Offices

Hybrid Workspace

Employees engage in a combination of remote and on-site work.

Optum has three workplace models that balance the needs of the business and the responsibilities of each role. These models, core on‑site (5 days/week), hybrid (4 days/week) and telecommute or fully remote, vary by country, role and location.

Typical time on-site: Not Specified
HQEden Prairie, MN
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