Senior Credentialing Representative - Quality Auditor

Title: Senior Credentialing Representative - Quality Auditor

Location: United States

Job Description:

Requisition number: 2349644

Job category: Network Management

Overtime status: Non-exempt

Travel: No

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.

The Senior Credentialing Representative is responsible for ensuring that credentialing information and data meets internal and external quality standards and requirements. Internal audits are performed against established standards for all credentialing and recredentialing functions within the Credentialing Center of Excellence (CCoE). The SCRA will document findings, identify trends, and recommend opportunities for improvement.

Location: Remote, Nationwide

Schedule: Monday to Friday, 8 AM- 5 PM

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

Primary Responsibilities:

Credentialing File Review/Audit:

• Performs daily audits of credentialing and recredentialing files utilizing standardized audit template
• Ensures audits are performed within established timeframes
• Communicates identified errors to credentialing representatives and specialists utilizing established processes

Process improvement:

• Participates in audit result review and track and trend of results
• Participates in root cause analysis
• Reviews repeat errors for potential training opportunities
• Provides explanations and interpretations within area of expertise
• Identifies potential process improvement needs to workflows and procedures
• Communicates potential and identified trends to leadership

Delegation Oversight:

• Collect and review credentialing files and materials for submission to delegating health plans at time of initial and annual delegation oversight audits
• Collect and review submitted sub-delegated files and materials at time of pre-assessment and annual delegation oversight audits
• Other department duties as assigned

Knowledge, Skills, and Abilities:

• Demonstrated understanding credentialing information processes  
• Established knowledge of credentialing requirements to include NCQA, CMS, and state-specific regulations
• Attention to detail, ability to identify inconsistencies and missing information
• Consistently delivers excellent quality of credentialing files processed
• Analytical and critical thinking skills
• Ability to research and evaluate credentialing criteria when questions or discrepancies are presented
• Strong communication skills, ability to communicate clearly and professionally in written or oral formats
• Ability to identify problems, analyze data and recommend solutions
• Ability to maintain confidential information in accordance with Company policies, state, and federal regulations
• Ability to manage detail and work with accuracy                                                
• Ability to acquire knowledge of technical resources within the organization
• Ability to work independently
• Ability to establish and maintain cooperative working relationships with individuals at all levels including teammates from other teams
• Ability to work with frequent interruptions
• Ability to prioritize work and skill in working effectively under deadlines and changing priorities
• Demonstrated knowledge of Microsoft Office applications such as Word, Excel, and Outlook
• Intermediate level skills working in Microsoft Excel
• Consistently delivers excellent quality of work

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions 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)
• 2+ years of experience in credentialing
• 1+ years of proven consistent quality audit scores passing or exceeding requirements
• 1+ years of experience using credentialing software or software managing provider information

Preferred Qualifications:

• Experience using MD-Staff credentialing software

*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 $20.38 to $36.44 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.