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Credentialing Representative - San Antonio TX

UnitedHealth Group San Antonio, TX
  • Expired: August 24, 2019. Applications are no longer accepted.

The Credentialing Specialist is responsible for processing credentialing and re-credentialing applications in accordance with department expectations, credentialing policies and procedures and regulatory requirements. Works closely with internal and external customers, ensuring the credentialing process is completed correctly, within established timeframes.
Primary Responsibilities:

  • Reviews applications for completeness, identifying discrepancies and potential issues.
  • Conducts verifications and queries as required by regulatory standards and departmental policies and procedures.
  • Responsible for timely and accurate multi-system data entry of provider additions, deletions and changes in accordance with departmental policies and procedures.
  • Maintains a working knowledge of contracting policies, procedures and processes, in an effort to provide cross-functional support to the contract services team on an as-needed basis.
  • Prepares and distributes reports in accordance with departmental procedures.
  • Assists in Credentialing Committee preparation, records minutes and promptly performs follow up actions as requested by Committee members as needed.
  • Meets or exceeds departmental timeframes and quality metrics on a consistent basis.
  • Maintains knowledge of credentialing policies and procedures and NCQA, URAC and CMS regulatory requirements.
  • Performs all other related duties as assigned
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 GED
Preferred Qualifications:
  • One or more years of administrative, database and / or data entry experience in credentialing or in a managed health care setting or related environment.
  • Must be able to maintain confidentiality while working with sensitive information.
  • Must be detail-oriented, well-organized and have the ability to multi-task effectively.
  • CPCS certification or willingness to pursue certification.
  • More than one year experience in managed care credentialing.
  • Knowledge of Microsoft Office software applications (Word, Excel and Access)
Careers 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: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords : Reimbursement, provider networks, San Antonio, TX, Texas

UnitedHealth Group


San Antonio, TX
78284 USA