Credentialing Support Coordinator - Remote in Arizona

Company: UnitedHealth Group
Location: Phoenix
Posted on: June 25, 2022

Job Description:

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)If you reside in Arizona, you will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. The Credentialing Support Coordinator is responsible for all activities associated with credentialing or re - credentialing physicians and providers. Includes processing provider provisional applications including initial mailing, review, and tracking files to ensure high quality standards are maintained. Conducts audits and provides feedback to reduce errors and improve processes and performance. Responsible for the development of credentialing policies and procedures. May oversee primary source verification activities.Primary Responsibilities:

• Ensure that practitioners and organizational providers are credentialed according to regulator and company standards
• Review application materials to determine if providers meet internal qualifying criteria for addition and/or continuation in networks
• Ongoing clean provider file review and process implementation in coordination with local Chief Medical Officer or designee
• Responsible for processing all provisional provider files (FQHC, CMO provisional requests) according to regulator 14-day timeframe
• Adhere to credentialing turnaround timeframes 1) Provisional: 14 days, 100%; 2) Initial: 75 days, 100%; 3) Organizational: 75 days, 100%; and 4) Recredentialing: every 3 years, 100%
• Ensure providers have appropriate credentials (e.g., state licenses; sanctions; Medicaid/Medicare identifications; hospital affiliation; board certification; malpractice insurance)
• Compare application information to credentialing source to ensure accuracy and completeness of provider application information
• Ensure verifications are completed within state, federal, and/or internally mandated timeframes (e.g., NCQA; URAC; CMS)
• Contact primary sources, credentialing agencies, and/or reference on-line information sources in order to verify provider credential information (e.g., licenses; education; Board certifications; DEA and/or CDS)
• Identify potential process improvement needs to provider analysis and verification procedures
• Refer submitted application and supporting documents to internal teams needed to approve or deny entrance into networks
• Contact and follow-up as needed with provider and/or request assistance to obtain missing information
• Conduct audits and provide feedback to reduce errors and improve processes and performance
• Lead role in coordinating Credentialing Committee (Provider Advisory Committee/PAC) activities to ensure accurate reports, records and minutes reflecting activities on an ongoing basis
• Coordinates Quality Management Committee (QMC) activities to ensure accurate reports, records and minutes reflecting activities on an ongoing basis
• Familiar with regulator standards (AHCCCS AMPM, Chapter 900, Policy 950)
• Responsible to meet regulator credentialing standards in Operational Reviews
• Oversees the collection, review, and documentation of practitioner data to include QI activities, UM profiles, member complaints and quality of care issues for recredentialing purposes
• Apply knowledge / skills to a range of complex activities
• Demonstrate great depth of knowledge / skills in own function and act as a technical resource to others
• Extensive work experience within own function
• Proactively identifies solutions to non-standard requests
• Plans, prioritizes, organizes, and completes work to meet established objectives
• Work is frequently completed without established procedures
• Work independentlyWhat are the reasons to consider working for UnitedHealth Group? - - Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. -Some of our offerings include:
  • Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
  • Medical Plan options along with participation in a Health Spending Account or a Health Saving account
  • Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
  • 401(k) Savings Plan, Employee Stock Purchase Plan
  • Education Reimbursement
  • Employee Discounts
  • Employee Assistance Program
  • Employee Referral Bonus Program
  • Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
  • More information can be downloaded at: -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 GED1 year of credentialing experience 1 year of experience working with compliance workflows and processes, including NCQA policies and practices1 year of healthcare experience1 year experience in researching and applying government regulatory information2 years of experience with Microsoft Excel (Creating reports, Sort and filter, Create formulas, Summary averages)2 years of experience with Microsoft Word Arizona residence only -Preferred Qualifications:

    Experience in healthcare provider credentialingCredentialing Certification Experience in computer software applications (e.g., databases, CAQH, National Practitioner Data Bank)To protect the health and safety of our workforce, patients, and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state, and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families, and veterans wherever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm)*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. - -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. -Keywords: Credentialing support coordinator, UHC, Arizona, remote, telecommute, work from home, work at home, WFH, WAH, hiring immediately, #RPO, #Yellow

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