UnitedHealth Group
Senior Provider Enrollment Representative
UnitedHealth Group, Brentwood, Tennessee, United States, 37027
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 of Enrollment
is a part of a team who is responsible for the oversight of enrollment and revalidation enrollment of OptumCare Allied Health Professional and Physician providers in 50 states and the US Virgin Islands. Enrollment functions include, but are not limited to, understanding of Center for Medicare Services (CMS) guidelines, Federal and State regulations & requirements, regularly participate with internal and external audits, understanding and operation of Council for Affordable Quality Healthcare (CAQH) ProView Portal, Provider Enrollment Chain and Ownership System (PECOS), collaborate with practitioners to prepare paper and electronic applications for submission to Medicare/Medicaid and various commercial & government payers expeditiously, maintain delegated health plan rosters on set schedule, setup/maintain group enrollments, setup/maintain group NPI's, maintenance of practice locations, and maintenance of Tax ID's. Proficient in performing job functions with minimal tutoring.
You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
Generate, complete, and submit applications for new and established enrollments with Medicare (PECOS), Medicaid, and various other Commercial/Government Health Plans
Meticulously review documents prior to transmission of applications via UPS/online and/or email to providers and health plans
Data entry and maintenance into database in accordance with internal policies and procedures with high-level accuracy
Process verification of State License and Prescriptive Authority Expirable prior to expiration monthly
Maintain assigned, and backup assigned, regions in all aspects of provider enrollment
Apply knowledge/skills to complex activities
Provide feedback to reduce errors and improve processes
Develop and maintain relationships with market leadership
Anticipate customer needs and proactively identify solutions
Independently and as a team solve complex problems
Prioritize work tasks independently
Participate with internal and external audits
Provide exceptional customer service to our internal and external contacts
Ability to work independently in a remote location with minimal supervision
Adapt well in a changing environment
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)
3+ years of experience with Health Plan Enrollment Processes
2+ years of experience with Medicare PECOS
2+ years of experience with CAQH and NPI database
Intermediate level of proficiency with Microsoft Office products
Preferred Qualifications:
Experience with: PECOS, CMS Regulations related to enrollment, and conducting web-based research
Be able to use:
Excel - sort, filter, import / export data, basic formulas
Word - create and modify docs, mail merge
Outlook - manage emails and calendars
Adobe Acrobat Pro - merge files and edit content
MD-Staff Database
CPCS Certification
PESC Certification
*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 $20.00 to $35.72 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
Caring. Connecting. Growing together.
The
Senior Credentialing Representative of Enrollment
is a part of a team who is responsible for the oversight of enrollment and revalidation enrollment of OptumCare Allied Health Professional and Physician providers in 50 states and the US Virgin Islands. Enrollment functions include, but are not limited to, understanding of Center for Medicare Services (CMS) guidelines, Federal and State regulations & requirements, regularly participate with internal and external audits, understanding and operation of Council for Affordable Quality Healthcare (CAQH) ProView Portal, Provider Enrollment Chain and Ownership System (PECOS), collaborate with practitioners to prepare paper and electronic applications for submission to Medicare/Medicaid and various commercial & government payers expeditiously, maintain delegated health plan rosters on set schedule, setup/maintain group enrollments, setup/maintain group NPI's, maintenance of practice locations, and maintenance of Tax ID's. Proficient in performing job functions with minimal tutoring.
You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
Generate, complete, and submit applications for new and established enrollments with Medicare (PECOS), Medicaid, and various other Commercial/Government Health Plans
Meticulously review documents prior to transmission of applications via UPS/online and/or email to providers and health plans
Data entry and maintenance into database in accordance with internal policies and procedures with high-level accuracy
Process verification of State License and Prescriptive Authority Expirable prior to expiration monthly
Maintain assigned, and backup assigned, regions in all aspects of provider enrollment
Apply knowledge/skills to complex activities
Provide feedback to reduce errors and improve processes
Develop and maintain relationships with market leadership
Anticipate customer needs and proactively identify solutions
Independently and as a team solve complex problems
Prioritize work tasks independently
Participate with internal and external audits
Provide exceptional customer service to our internal and external contacts
Ability to work independently in a remote location with minimal supervision
Adapt well in a changing environment
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)
3+ years of experience with Health Plan Enrollment Processes
2+ years of experience with Medicare PECOS
2+ years of experience with CAQH and NPI database
Intermediate level of proficiency with Microsoft Office products
Preferred Qualifications:
Experience with: PECOS, CMS Regulations related to enrollment, and conducting web-based research
Be able to use:
Excel - sort, filter, import / export data, basic formulas
Word - create and modify docs, mail merge
Outlook - manage emails and calendars
Adobe Acrobat Pro - merge files and edit content
MD-Staff Database
CPCS Certification
PESC Certification
*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 $20.00 to $35.72 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