Senior Credentialing Specialist - San Antonio, TX

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Careers at UnitedHealth Group

We're creating opportunities in every corner of the health care marketplace to improve lives while we're building careers. At UnitedHealth Group, we support you with the latest tools, advanced training and the combined strength of high caliber co-workers who share your passion, your energy and your commitment to quality. Join us and start doing your life's best work. SM

Clinical

Compassion. It's the starting point for health care providers like you and it's what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you're also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life's best work. SM

Our teams are helping people from around the world. We can bring out your best as you put your listening, analytical and problem solving skills to work in a setting that is geared to helping improve lives and enhance health care for millions. Here, you'll discover a wealth of pathways for professional growth within Customer Service, Billing, Claims, Enrollment & Eligibility and across our global economy. Join us and find out why this is the place to do your life's best work. SM

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life's best work.(sm)

It's that time, isn't it? You're ready for the next step forward and an opportunity to build on your skills. And it just so happens that there's never been a better time to become a part of the team at UnitedHealth Group. We're building and maintaining extensive provider networks to serve our customers. Our goal is to attract and secure relationships with the best in every specialty and every community. As a senior member of our provider credentialing team, you'll help us vet and document the competencies of physicians and other providers in our networks. As you do, you'll discover the resources, backing and opportunities that you'd expect from a Fortune 7 leader.

The Senior Credentialing Specialist is responsible for processing credentialing and recredentialing applications in accordance with department expectations, policies and procedures and regulatory requirements. Functions as a team lead, providing direction, training and leadership to Credentialing Specialists as necessary. This position performs internal quality review audits on credentialing files. The Senior Credentialing Specialist is responsible for delegation oversight including data exchange, maintenance of reports and reporting schedules. Performs delegation audits, to include review of policies and procedures and file audits ensuring compliance with CMS, NCQA, URAC and state regulations.

Primary Responsibilities:
  • Performs quality review audits on 100% of credentialing files, while maintaining a personal quality average of 95% or higher
  • Takes ownership of the total work process to include system modifications and training, while providing constructive guidance to minimize problems and create efficiencies
  • Maintains delegate files in accordance with the standards set forth by internal policies and procedures and external regulatory requirements
  • Coordinates with all delegates to ensure timely and accurate receipt and transmission of additions, terms and changes to network physician information
  • Performs annual delegation audits as well as pre-delegation assessments, including policy and procedure review and file review to ensure regulatory compliance
  • Engages in development, communication and follow-up for corrective action plans for delegated providers
  • Preparing weekly sign-offs, updating IntelliSoft with provider credentialing effective dates, notifying appropriate departments of provider approval and sending approval letters to providers in a timely manner
  • Assists in the preparation and maintenance of departmental and IntelliSoft training materials and staff training regarding departmental procedures
  • Completes required modifications to IntelliSoft to ensure proper entry of provider credentialing information
  • Meets or exceed departmental timeframes and quality metrics on a consistent basis
  • 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
  • 3+ years of administrative, database and/or data entry experience in credentialing or in a managed health care setting or related environment
  • Experience maintaining confidentiality while working with sensitive information
  • Knowledge of Microsoft Office applications with a concentration in Excel
  • You will be asked to perform this role in an office setting or other company location
  • Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive VoiceResponse (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained

Preferred Qualifications:
  • CPCS Certification or willingness to pursue certification
  • 2+ years of experience in managed care credentialing operating environment
  • Detail-oriented, well-organized and ability to multi-task effectively


Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 550,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)

WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth.

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: Senior Credentialing Specialist, Credentialing Specialist, San Antonio, TX, Texas

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