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Job Information

UnitedHealth Group Senior Credentialing Specialist - San Antonio, TX in San Antonio, Texas

It's that time, isn't it? You're ready for the next step forward and an opportunity to build on your skills. And it just so happens that there's never been a better time to become a part of the team at UnitedHealth Group. We're building and maintaining extensive provider networks to serve our customers. Our goal is to attract and secure relationships with the best in every specialty and every community. As a senior member of our provider credentialing team, you'll help us vet and document the competencies of physicians and other providers in our networks. As you do, you'll discover the resources, backing and opportunities that you'd expect from a Fortune 6 leader.

The Senior Credentialing Specialist is responsible for processing credentialing and recredentialing applications in accordance with department expectations, policies and procedures and regulatory requirements. Functions as a team lead, providing direction, training and leadership to Credentialing Specialists as necessary. This position performs internal quality review audits on credentialing files. The Senior Credentialing Specialist is responsible for delegation oversight including data exchange, maintenance of reports and reporting schedules. Performs delegation audits, to include review of policies and procedures and file audits ensuring compliance with CMS, NCQA, URAC and state regulations.

Primary Responsibilities:

  • Performs quality review audits on 100% of credentialing files, while maintaining a personal quality average of 95% or higher

  • Takes ownership of the total work process to include system modifications and training, while providing constructive guidance to minimize problems and create efficiencies

  • Maintains delegate files in accordance with the standards set forth by internal policies and procedures and external regulatory requirements

  • Coordinates with all delegates to ensure timely and accurate receipt and transmission of additions, terms and changes to network physician information

  • Performs annual delegation audits as well as pre-delegation assessments, including policy and procedure review and file review to ensure regulatory compliance

  • Engages in development, communication and follow-up for corrective action plans fordelegated providers

  • Responsible for preparing weekly sign-offs, updating IntelliSoft with provider credentialing effective dates, notifying appropriate departments of provider approval and sending approval letters to providers in a timely manner

  • Assists in the preparation and maintenance of departmental and IntelliSoft training materials and staff training regarding departmental procedures

  • Completes required modifications to IntelliSoft to ensure proper entry of provider credentialing information

  • Meets or exceed departmental timeframes and quality metrics on a consistent basis.

  • Performs all other related 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 required

  • Three to five years of administrative, database and / or data entry experience in credentialing or in a managed health care setting or related environment

  • Knowledge of Microsoft Office applications with a concentration in Excel

  • Must be able to maintain confidentiality while working with sensitive information

  • Must be detail-oriented, well-organized and have the ability to multi-task effectively

  • Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive VoiceResponse (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained

  • You will be asked to perform this role in an office setting or other company location

Preferred Qualifications:

  • CPCS Certification or willingness to pursue certification

  • 2+ years experience in managed care credentialing operating environment

Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 380,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)

WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth.

© 2018 OptumCare. All Rights Reserved.

OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare's support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment