10 days old

Sr Credentialing Rep - San Antonio, TX

San Antonio, TX 78205
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  • Job Code
    875141
The Senior Credentialing Specialist is responsible for processing credentialing and re-credentialing 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
  • Responsible for 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.
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Posted: 2020-05-20 Expires: 2020-06-19

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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Sr Credentialing Rep - San Antonio, TX

UnitedHealth Group
San Antonio, TX 78205

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