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.

This position is full time. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime.

We offer 2 weeks of shadowing / on-the-job training. The hours of the training will be based on schedule or will be discussed on your first day of employment.

You’ll 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 Expirables 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 equivalent work experience

• Must be 18 years of age or older

• 3+ years of experience of Provider Enrollment Processes

• 2+ years of experience with PECOS

• 2+ years of experience with CAQH

• Intermediate level of proficiency with Microsoft Office products

• Ability to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 5:00pm.

Preferred Qualifications:

• Experience with: PECOS, CMS Regulations related to enrollment, and conducting web‐based research

• Ability to use Microsoft Excel – sort, filter, import / export data, basic formulas

• Ability to use Microsoft Word – create and modify docs, mail merge

• Ability to use Microsoft Outlook – manage emails and calendars

• Adobe Acrobat Pro – merge files and edit content

• MD-Staff Database

• CPCS Certification

• PESC Certification

Telecommuting Requirements:

• Ability to keep all company sensitive documents secure (if applicable)

• Required to have a dedicated work area established that is separated from other living areas and provides information privacy.

• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Washington, Rhode Island, OR Washington, D.C. Residents Only: The hourly range for this is $19.47 - $38.08 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

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.

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 .

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