Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.(sm) The Credentialing Specialist is responsible for all activities associated with credentialing or re - credentialing physicians and providers. Includes processing provider applications and re - applications including initial mailing, review, and loading into the database tracking system ensuring high quality standards are maintained. Credentialing Specialists will conduct audits and provide feedback to reduce errors and improve processes and performance. Other responsibilities include the development of credentialing policies and procedures, and may oversee primary source verification activities. Primary Responsibilities: Use pertinent data and facts to identify and solve a range of problems within area of expertise Investigate non - standard requests and problems, with some assistance from others Work exclusively within a specific knowledge area Prioritize and organize own work to meet deadlines Provide explanations and information to others on topics within area of expertise Design and complete data analysis projects for department customers including defining informational needs, appropriate methodologies and report formats. Provide written reports with accompanying documentation of findings Conducts audits of the credentialing database, confirming accurate input of provider data, including auditing other staff data entry and verifying accuracy of modifications made to the database Monitor security of data within the Credentialing Database with individuals to whom data or system access may be given; report infractions to the Credentialing Supervisor Maintain current knowledge of computer hardware and database software capabilities Orient new staff to appropriate database use, capabilities, security, etc. Act as project leader and assist in the development of provider data reporting, as requested Collaborate with Information Technology to review approved software installs, upgrades, incremental backups and restorations; assist in the development of configuration documentation and updates as necessary Maintain appropriate logs of database - related problems and modifications; monitor database performance and space; investigate and resolve all departmental problems, questions and concerns and make modifications, as necessary. Report all systemic database issues to Supervisor Disseminate new / modified professional information to HMOs and to internal departments through the Information System Change Control Process Process credentialing / re - credentialing applications accurately and promptly in accordance with internal medical group policies and procedures and NCQA standards. Coordinate the credentialing and re - credentialing processes with the Quality Improvement Department and other internal departments, as necessary Prepare materials and files necessary to comply with external audits by health plans or governmental agencies Accepts and performs other duties and responsibility as assigned
Required Qualifications: Undergraduate degree or equivalent healthcare experience 3+ years of experience with credentialing / re-credentialing and / or privileging in the healthcare industry 2+ years of experience with healthcare accreditation and regulatory standards including NCQA requirements Intermediate level of proficiency with MS Excel and Access Intermediate level of proficiency in performing research Must be eligible to take the National Association Medical Staff Services (NAMSS), Certified Provider Credentialing Specialist exam within the first 18 months of employment Demonstrated ability to organize and manage multiple ongoing projects within expected timeframes Preferred Qualifications:2+ years' experience in credentialing, preferably in a managed care setting Advanced Access and Excel knowledge Knowledge of Practice Management Software and eVIPs Software System Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system 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) 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: Credentialing Specialist, Credentialing, NCQA, NAMSS, eVIPS, Las Vegas, NV, Nevada
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.