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.

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

Primary Responsibilities

• Performs tracking and follow-up to ensure provider numbers are established and linked to the appropriate
• OHMG group entity in a timely manner
• Ensures that established provider numbers are communicated to professional billing in order to release pended claims and to clinic managers for patient scheduling
• Assists finance department in identifying patient population needs and targeting payers for contracting
• Manages each provider’s Council for Affordable Quality Healthcare (CAQH) and National Provider Identifier (NPI) accounts
• Establishes close working relationships with providers, office managers, professional billing, and payer contacts
• Participates in on-boarding and network representative meetings
• Maintains provider enrollment information within the credentialing database and pulls reports for hospital administration, marketing, professional billing staff, and clinic directors/managers as needed
• Upon receipt of applications ensures all required information is contained therein, assembles the information, and prepares credentials files for submission to government and commercial payers
• Identifies and reviews credentialing red flags with OHMG managers and directors
• Maintains calendar of provider licensure, certificate of insurance, and network expirations
• Submits Annual Disclosures of Ownership (ADOs) and re-validations to Medicare and Medicaid on all providers and practices
• Manages the process for credentialing and re-credentialing of all OHMG providers per the time schedule established by each contracted network
• Assists OHMG providers, clinic directors, and office managers in a thorough understanding of the credentialing/enrollment processes and policies

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)
• 4+ years of health care provider payer enrollment credentialing experience
• 2+ years experience working with compliance workflows and processes, including NCQA policies and practices
• 2+ years experience in researching and applying government regulatory information
• Intermediate level of proficiency with MS Excel and Word

Preferred Qualifications:

• Experience with MD Staff database software
• Experience with Kentucky and Indiana payer enrollment credentialing experience

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

For more information on our Internal Job Posting Policy, click here.

California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island, Hawaii, Washington, or Washington D.C Residents Only: The hourly range for California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island, Hawaii, Washington, or Washington D.C residents is $19.47 to $38.08 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.

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.

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.

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