Credentialing Specialist - San Antonio, TX - Full-time / Part-time

Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.(sm)

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

Required Qualifications:

• High School diploma or GED


• 1+ years of administrative, database and / or data entry experience in credentialing or in a managed health care setting or related environment


• Ability to maintain confidentiality while working with sensitive information


• Detail-oriented, well-organized and have the ability to multi-task effectively

Preferred Qualifications:

• CPCS certification or willingness to pursue certification


• 1+ years of experience in managed care credentialing


• Knowledge of Microsoft Office software applications (Word, Excel and Access)

WellMed is a healthcare delivery system serving more than 90,000 patients, primarily Medicare eligible seniors, in Texas and Florida through primary care clinics, multi-specialty clinics, and contracted medical management services. Headquartered in San Antonio, Texas, WellMed is an industry leader in medical risk management, highly effective disease management and chronic care programs, healthcare delivery services and more.

Our focus and mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. We are innovators in preventative healthcare, striving to change the face of healthcare delivery for seniors. Our providers and support staff are selected for their dedication to the senior population and focus on preventative, proactive patient care.

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system 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: 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 Specialist, Credentialing Representative, Network Credentialing, Managed Care, healthcare, credentialing, claims, provider applications, medical insurance, provider relations, medical billing, San Antonio, TX, Texas