21 days old

Payer Credentialing Coordinator - Boulder, CO - 909292

Boulder, CO 80302
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  • Job Code
    909292

Here you are in the earlier stages of what could be a deeply rewarding career. You have the potential, the energy and the aspiration to take on meaningful challenges and make a difference. Now, let's talk about what you can do with our leading, global health care organization. UnitedHealth Group is 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 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 7leader.

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Primary Responsibilities:

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  • Responsible for completing the process of credentialing providers employed by the Community Medical Associates (CMA) group for Boulder Community Health as required by each payer contract and government payer regulations
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  • Responsible for re-credentialing providers via CAQH every 120 days to ensure provider credentialing statuses remain consistent.
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  • Coordinate with BCH Medical Staff Office to ensure all applicable documents are acquired for timely credentialing of providers.
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  • Communicate with representatives from managed care organizations and the BVIPA to update physician roster lists when appropriate.
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  • Update and communicate provider credentialing status when employment termination occurs
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  • When necessary, work collaboratively with hospital reimbursement specialists to update Medicare 855A forms.
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  • Maintain and update Medicare 855B enrollment for CMA group locations and providers
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  • Update Provider Enrollment, Chain and Ownership System (PECOS) and National Plan & Provider Enumeration System (NPPES) when appropriate.
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  • Set meetings with providers to complete necessary credentialing paperwork or acquire necessary signatures when needed.
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  • Maintain the confidentiality of all verbal and written communications and all collected data, as appropriate
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  • Serve as an educational resource to providers and staff concerning credentialing activities
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  • Serve as the primary liaison between billing staff and payers when reimbursement issues arise due to credentialing activities
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  • Update and maintain timely credentialing matrix for providers and staff to have an accurate picture of current credentialing activities and status
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  • Communicate with IT analysts and Billing Office staff when provider statuses change in order to facilitate correct billing.
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  • Creates ad hoc reports upon request from Director of Physician Revenue Cycle, Physician Billing Manager, Compliance Department, or Medical Staff Department
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  • Participates in department and hospital committees/projects as needed/requested
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  • Attends appropriate continuing education seminars
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  • Meets monthly with Director of Physician Revenue Cycle and Physician Clinics Billing Manager to give updates on credentialing activities
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  • Consistent and on time attendance is an essential function of position
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  • Employees are expected to comply with all regulatory requirements, including Joint Commission Standards
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Youll 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.

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Required Qualifications:

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  • High school diploma/GED or above
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  • 2+ years of experience with physician and\\or hospital billing or working in a healthcare related setting
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  • 1+ years experience in credentialing providers, working in provider relations, medical billing or quality management
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  • Proficiency with MS Word, Excel, Outlook, and other Microsoft Office applications
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  • You will be asked to perform this role in an office setting or other company location
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  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas, In addition, employees must comply with any state and local masking orders.
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UnitedHealth Group is an essential business. The health and safety of our team members is our highest priority, so we are taking a science driven approach to slowly welcome and transition some of our workforce back to the office with many safety protocols in place. We continue to monitor and assess before we confirm the return of each wave, paying specific attention to geography-specific trends. We have taken steps to ensure the safety of our 325,000 team members and their families, providing them with resources and support as they continue to serve the members, patients and customers who depend on us.

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You can learn more about all we are doing to fight COVID-19 and support impacted communities: click here.

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Colorado Residents Only: The hourlyrange for Colorado residents is $15.00to $25.19. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

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Diversity creates a healthier atmosphere: 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.

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UnitedHealth Groupis a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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"Job Keywords: health care, healthcare, Managed Care, Optum, OptumRx, UnitedHealthcare, credentialing, coordinatorUnitedHealth Group, retail pharmacy, hiring immediately

Posted: 2021-02-06 Expires: 2021-03-08

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Payer Credentialing Coordinator - Boulder, CO - 909292

UnitedHealth Group
Boulder, CO 80302

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