580030 - Healthcare Provider Credentialing Specialist - Waltham, MA - 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)

UnitedHealth Networks, part of the UnitedHealth Group family of companies, is now looking for a Credentialing Specialist for our team in Waltham MA. You will be responsible for all activities associated with credentialing or re-credentialing physicians and providers. Includes processing provider applications and re-applications including initial mailing, review, and loading into the database tracking system ensuring high quality standards are maintained. Credentialing Specialists will conduct audits and provide feedback to reduce errors and improve processes and performance. Other responsibilities include the development of credentialing policies and procedures, and may oversee primary source verification activities.

Primary Responsibilities:

• Use pertinent data and facts to identify and solve a range of problems within area of expertise


• Investigate non-standard requests and problems, with some assistance from others


• Work exclusively within a specific knowledge area


• Prioritize and organize own work to meet deadlines


• Provide explanations and information to others on topics within area of expertise
• Other duties as assigned
  

Required Qualifications:

• Undergraduate degree or 5+ years of related experience


• 3+ years of experience in the healthcare and/or health insurance industries


• 3+ years of experience with credentialing/recredentialing and/or privileging in the healthcare industry


• 2+ years of experience with healthcare accreditation and regulatory standards including NCQA requirements


• Demonstrated ability to organize and manage multiple ongoing projects within expected timeframes


• Must show attention to detail and be capable of taking responsibility for completion of assigned projects within deadlines


• Professional verbal and written communication skills, including the ability to develop correspondence to facilities and clinicians


• At least an intermediate level of proficiency with MS Excel & MS Word

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place 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: health, healthcare, medical, hospital, clinic, provider, credentialing, Waltham, Boston, Massachusetts, MA