Credentialing Specialist - Remote in Florida

About the role

The goals of our LTC network team are to manage and carry out the provider network requirements and all functions related to credentialing and re-credentialing. Provider Relations experience is a plus, Microsoft Excel intermediate to advanced level is required due to the needs of network reporting.

Responsibilities

• Communicate with providers and office administrators regarding credentialing/re-credentialing, licensure and demographics, contracting efforts, etc. for the Medicaid Long Term Care business
• Manage and carry out the provider network requirements and all functions related to credentialing and re-credentialing
• Process provider applications and re-applications including initial mailing, review, and loading into the database tracking system ensuring high quality standards are maintained
• Conduct audits and provide feedback to reduce errors and improve processes and performance
• Develop credentialing policies and procedures
• Oversee primary source verification activities
• Contribute to establishing and maintaining strong business relationships with Ancillary providers, ensuring the network composition includes an appropriate distribution of provider specialties
• Aid network team with tasks related to ancillary groups & facilities yielding a geographically competitive, broad access, stable network (Medicaid/Long Term Care)
• Review and submit contracts for system loading to include verification and accuracy of base agreements and payment appendices
• Distribute pertinent information to providers via FAX and EMAIL blasts such as Alerts from our State Agency, network requirement changes and/or updates, and other information related to Medicaid Long Term Care provider network management

Qualifications

• High School Diploma / GED
• 3+ years of experience/knowledge in the Agency for Healthcare Administration Statewide Medicaid Managed Care (SMMC) Medicaid/Long Term Care business
• 3+ years of experience working in a network management-related role, such as provider services, credentialing, contract processing
• 3+ years of experience and/or certification in ancillary credentialing, to include knowledge of credentialing requirements for the state of Florida
• 1+ years of experience in fee schedule management
• 1+ years of experience in network adequacy analysis
• Intermediate level of proficiency in Microsoft Word, Excel, PowerPoint, Databases (user-end)
• Intermediate level of proficiency with email and Internet programs such as Outlook and Teams, Chrome, Edge
• Advanced level of written and verbal English language proficiency
• Must reside in the state of Florida

Preferred Qualifications

• Associate's degree or higher in Business and/or Healthcare Administration
• Experience working with Health Services staff (Care Managers) regarding authorizations and identifying in-network providers to provide services to Long Term Care members
• English/Spanish Bilingual is a plus (English being the primary language)

Soft Skills

• Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information form others
• Strong interpersonal skills, establishing rapport and working well with others
• Strong customer service skills as this role serves as managing the incoming and outgoing communications for the Long-Term Care provider network department
• High level of organizational skills with capability to prioritize and adapt to frequently changing tasks and objectives

Pay and Benefits

• Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc.
• In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives.
• The hourly pay for this role will range from $18.00 to $32.00 per hour based on full-time employment.
• We comply with all minimum wage laws as applicable.

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.
• 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.
• 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.