UnitedHealth Group

UnitedHealth Group is a healthcare and well-being company that’s dedicated to improving the health outcomes of millions around the world. We are comprised of

Credentialing and Enrollment Specialist

Location

United States

Posted

1 day ago

Salary

$20 - $36 / hour

Seniority

Mid Level

Job Description

Credentialing and Enrollment Specialist

UnitedHealth Group

Role Description The Credentialing and Enrollment Specialist is responsible for activities associated with credentialing or re-credentialing physicians and providers, including processing provider applications and re-applications. - Location: Remote Nationwide - Schedule: FT, 40 hrs. Monday – Friday, 8am – 5pm - You’ll enjoy the flexibility to work remotely from anywhere within the U.S. Primary Responsibilities: - Apply knowledge/skills to a range of moderately complex activities - Demonstrate great depth of knowledge/skills in own function - Sometimes act as a technical resource to others in own function - Meet with Medical Director to review initial and reappointment applications - Meet with AAAHC and State Auditors to review files - Primary Source Verification Process for initial and reappointments - Maintain expirable for all employed and non-employed clinicians at ASCs - Compile and generate Credentialing Committee Minutes - Perform internal audits on credentialing and re-credentialing files for accuracy and maintaining compliance with credentialing policies and procedures - Maintaining knowledge of and compliance with TJC, NCQA, CAQH, and CMS standards, as appropriate - Monitoring upcoming renewal dates and working with medical staff to advise them on steps to maintain their credentials - Proactively identify solutions to non-standard requests - Solve moderately complex problems on own - Work with team to solve complex problems - Presentation skills to group setting - Plan, prioritize, organize and complete work to meet established objectives - May coordinate work of other team members - Credentialing of medical group providers and hospital privileging application review and submission at the individual and group level - Complete revalidation requests with government and commercial payers - Track and maintain medical professionals’ licensure, certifications, etc. - Work with other organizational departments internal/external to ensure that credentialing efforts are in line with business objectives Qualifications - High School Diploma/GED - 3+ years of Healthcare Provider group/Facility Credentialing experience - 2+ years of experience in healthcare administration, medical staff services, health information management - 2+ years of experience with credentialing processes, medical staff privilege and knowledge of relevant software or databases used in credentialing - Intermediate level of proficiency with Microsoft Excel and Word - Ability to work Pacific time zone hours Requirements - Experience working with Compliance Workflows and Processes including AAAHC, JC, CMS, and NCQA Policies - Experience in researching and applying Government Regulatory Information - Knowledge of CAQH - Knowledge of MD Staff credentialing databases - Data analytics - Pecos enrollment - Proven ability to plan and prioritize to meet benchmarks/deadlines Benefits - Comprehensive benefits package - Incentive and recognition programs - Equity stock purchase - 401k contribution (all benefits are subject to eligibility requirements) - Hourly pay for this role will range from $20 to $36 per hour based on full-time employment

Related Job Pages

More Threat Intelligence Specialist Jobs

Molina Healthcare logo

Critical Incidents Specialist

Molina Healthcare

Molina Healthcare is a Fortune 500 managed care company with a storied history that dates back to 1980 and the opening of a medical clinic by Dr. C. David Molina. As an employer, M

Role Description Provides support for critical incident management activities, including provision of critical incident management referral support to members. Strives to ensure member progress toward desired outcomes in conjunction with interdisciplinary team facilitating integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. Please Read: While this is a remote position, this role requires the ability to be camera ready at any moment as this position meets with state and other government officials on a regular basis. There is a strong preference for the chosen candidate to live in New Mexico but we are open to team members who are willing to work MST time to support the needs of this team. This role works Mon-Friday 8-5PM, MST. - Supports key components of the critical incident management process including: collaborating with members and multidisciplinary team to assess, facilitate, plan, and coordinate integrated delivery of care. - Monitors email inboxes for critical incident referrals. - Reviews critical incidents via the dedicated electronic documentation system. - Monitors and ensures that key activities within incident management process are completed on time and accurately. - presents data to departmental leadership and other stakeholders as needed/appropriate. - Focuses on learning and systematic improvement. Qualifications - At least 3 years health care experience, preferably in a capacity supporting critical health incidents, member health and safety, or risk mitigation, or equivalent combination of relevant education and experience. - Registered Nurse (RN). License must be active and unrestricted in state of practice. - Solid business/clinical writing/documentation experience. - Strong attention to detail and organizational skills. - Ability to adhere to strict time constraints. - Excellent verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. Requirements - Previous critical incident, member health and safety, and or risk mitigation experience. - Previous experience working with persons with disabilities and the frail elderly. - Previous Electronic Medical Record (EMR) experience, and understanding of Health Insurance Portability and Accountability Act (HIPAA). Benefits Molina Healthcare offers a competitive benefits and compensation package. Company Description Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

United States
$24 - $51 / hour
Skillcerto logo

Market Intelligence Analyst – Real Estate

Skillcerto

🔎 Pode me chamar de skill 💚 Nossa mira é certeira, sua equipe imbatível 👊 Recrutamento e Seleção 🧐

Full TimeRemoteTeam 11-50Since 2024H1B No Sponsor

• Analyze commercial and marketing metrics (sales, leads, funnel, conversion, VSO, targets vs. actual) • Conduct strategic meetings with clients to review results and provide recommendations • Propose commercial and marketing action plans based on data • Act as a strategic consultant within client contracts • Support decisions on launches, campaigns, commercial structure and targets • Work closely with clients' commercial and marketing teams • Collaborate with the internal team to deliver strategic, high-impact outputs

Brazil

Contract Specialist III

Chenega Government Mission Solutions

Many of our jobs come with great benefits – Some offerings are dependent upon the role, work schedule, or location. Teleworking Permitted? Yes Teleworking Details: Can be onsite, hybrid, or remote (US) Estimated Salary/Wage: USD $82,000.00/Yr. Up to USD $112,000.00/Yr.

Role Description Come join a company that strives for Extraordinary People and Exceptional Performance! Chenega Government Mission Solutions, LLC, a Chenega Professional Services’ company, is looking for a Contract Specialist III to support the Division of Acquisition Management (DAM) at the Phoenix Area Office (PAO) The Indian Health Service (IHS), an agency within the Department of Health and Human Services (HHS). Responsibilities include: - Provide direct support to Federal contracts specialists with tasks such as: - Soliciting - Completing contracting modifications for various actions to include complex or funding only actions - Ensure invoicing is completed and received by Federal staff - Create a doctor and nurse tracking log, including hour counts and projections, and period of performance with transition dates - Manage a contract and requisition tracking log by creating and supporting strong measures for data validation and reporting - Interacting with Federal staff to act as a point of contact on all doctor and nursing contracting actions - Data analysis on federal contracts to create meaningful and actionable data on past and future contracting actions, including cost variance and spending to ensure contracts are fully funded to prevent ratifications and confirming orders - Contractor performance analysis for providers and nurses to ensure goals are met - Other duties as assigned Qualifications - Baccalaureate degree in business or equivalent - Minimum 5+ years in Government Contracting - Specialized experience in closeouts, data analysis, cost analysis, and expedited contract actions - Minimum 4+ years in healthcare with knowledge about hospital/clinic staffing and professions Requirements - Preferred understanding of providing rural healthcare services - Advanced knowledge of Federal contracting principles and FAR requirements, including solicitations, complex and funding‑only contract modifications, expedited actions, and contract closeouts - Strong analytical skills to perform cost analysis, funding validation, spending forecasts, and cost variance analysis to ensure contracts are fully funded and compliant - Proven ability to manage and validate contract, requisition, and staffing tracking logs, including provider hours, projections, periods of performance, and transition timelines - Healthcare contracting expertise, including physician and nursing services, hospital/clinic staffing models, and preferred experience supporting rural healthcare environments - Effective communication and stakeholder coordination skills, serving as a primary point of contact with Federal staff on all doctor and nursing contracting actions and invoicing processes - Ability to analyze contractor performance data and develop actionable insights to assess provider and nurse performance, mitigate risks, and support informed contracting decisions Benefits - Paid Time Off - PTO / Vacation – 5.67 hours accrued per pay period / 136 hours accrued annually - Paid Holidays - 11 - California residents receive an additional 24 hours of sick leave a year - Health & Wellness: - Medical - Dental - Vision - Prescription - Employee Assistance Program - Short- & Long-Term Disability - Life and AD&D Insurance - Spending Account - Flexible Spending Account - Health Savings Account - Health Reimbursement Account - Dependent Care Spending Account - Commuter Benefits - Retirement: - 401k / 401a - Voluntary Benefits: - Hospital Indemnity - Critical Illness - Accident Insurance - Pet Insurance - Legal Insurance - ID Theft Protection Company Description Many of our jobs come with great benefits – Some offerings are dependent upon the role, work schedule, or location. Teleworking Permitted? Yes Teleworking Details: Can be onsite, hybrid, or remote (US) Estimated Salary/Wage: USD $82,000.00/Yr. Up to USD $112,000.00/Yr.

United States
$82K - $112K / year
Motive - Fleet Management Software logo

Save Specialist - Spanish

Motive - Fleet Management Software

Motive Technologies, Inc., formerly known as KeepTruckin, is on a mission to modernize trucking by bringing the industry online with its fleet management softwa

Full TimeRemoteTeam 4,000Since 2013

Who we are: Motive empowers the people who run physical operations with tools to make their work safer, more productive, and more profitable. For the first time ever, safety, operations and finance teams can manage their drivers, vehicles, equipment, and fleet related spend in a single system. Combined with industry leading AI, the Motive platform gives you complete visibility and control, and significantly reduces manual workloads by automating and simplifying tasks. Motive serves nearly 100,000 customers – from Fortune 500 enterprises to small businesses – across a wide range of industries, including transportation and logistics, construction, energy, field service, manufacturing, agriculture, food and beverage, retail, and the public sector. Visit gomotive.com to learn more. About the Role:Save Specialist is responsible for relationship building with Motive customers. This position coordinates, executes, and manages programs built to effectively retain customers through positive relationship-building, listening to concerns/addressing issues and educating customers on the value of our products. A customer-oriented focus is necessary in order to preserve long-term customer satisfaction. This position requires someone that is highly organized, has excellent communication skills and demonstrates good judgment. What You'll Do: - Identify signals of at-risk accounts and collaborate with internal teams to remediate and ensure a successful renewal - Handle large volume of phone conversations and email inquiries - Maximize customer lifetime value and minimize churn risk while increasing overall customer satisfaction and identifying up-sell opportunities - Build quick rapport with customers and apply both persuasive rebuttal skills and problem solving strategies while providing solutions - Problem solving is a must as you quickly identify the root cause of customer issues and work with them to implement fair contract negotiations What We're Looking For: - 2+ years prior experience in a customer facing role (sales and/or support) - Ability to speak fluent Spanish - Strong ability to build and maintain customer relationships - Effective listening and problem-solving skills - Excellent communication (both written and verbal) and presentation skills - Proven ability to manage multiple responsibilities with a high attention to detail and professionalism Creating a diverse and inclusive workplace is one of Motive's core values. We are an equal opportunity employer and welcome people of different backgrounds, experiences, abilities and perspectives. Please review our Candidate Privacy Notice here. UK Candidate Privacy Notice here. The applicant must be authorized to receive and access those commodities and technologies controlled under U.S. Export Administration Regulations. It is Motive's policy to require that employees be authorized to receive access to Motive products and technology. All job postings are for existing vacancies. Please note; some interviews or new-hire training sessions may be held in person at one of our global offices.

Pakistan