The Credentialing Coordinator is responsible for activities associated with credentialing or re-credentialing physicians and providers and maintaining accurate and up to date provider information. Responsibilities include processing provider applications and re-applications including initial mailing, review, and loading into the database tracking system ensuring high quality standards are maintained. Primary Responsibilities: Coordinate credentialing and re-credentialing processes, maintaining task grids and tickler systems to assure follow up and completionResponsible for accurate input and modifications to the credentialing database and for performing audits to assure accuracySupport and maintain database problems and modifications. Monitor database performance; investigate and resolve database questions and concerns, making modifications, as necessary. Report all systemic database issues to SupervisorPrepare materials and files necessary to comply with external audits by health plans and/or governmental agencies. Maintain ongoing communication with health plan representatives and contracted providers. Perform follow up and complete requests, as necessaryDisseminate new/modified professional information to health plans and internal departmentsDevelop, maintain, and provide reports from the department database and prepares custom reports, data searches and/or data analysis in response to specific requests by internal or external customersCreate and maintain files and filing system for health care professionals participating under group agreements. Verify credentials and complete processes to comply with internal standards
Required Qualifications:High School Diploma or GEDIntermediate level of proficiency with Microsoft Excel and WordExperience with data entry and/or researchPreferred Qualifications: Healthcare and/or managed care credentialing experienceFamiliarity with eVIPs software or other credentialing softwareExperience working with compliance workflows and processes including NCQA policies and practicesExperience in researching and applying government regulatory InformationKnowledgeable of CAQHCareers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care 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 Coordinator, data entry, research, CAQH, eVIPs, credentialing, 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.