Credentialing Representative

Are you a detail-oriented professional with a passion for healthcare? Do you have a knack for managing complex processes and ensuring accuracy? If so, we have an exciting opportunity for you at UnitedHealth Group as a Credentialing Representative.In this role, you will play a crucial part in maintaining the integrity of our provider network by verifying credentials and ensuring compliance with regulatory standards. Your strong communication skills and ability to build relationships will be essential as you collaborate with various stakeholders to complete the credentialing process.To succeed in this role, you must have a high school diploma or equivalent, at least one year of experience in healthcare administration or a related field, and a working knowledge of credentialing processes and regulations. Additionally, strong organizational skills, attention to detail, and the ability to adapt to changing priorities are a must. Join our team and make a difference in the healthcare industry while growing your career with a leading company.

1. Verify and maintain the credentials of healthcare providers within the network to ensure compliance with regulatory standards.
2. Communicate and collaborate with various stakeholders, including providers, internal teams, and external organizations, to complete the credentialing process.
3. Manage complex processes and prioritize tasks to ensure timely completion of credentialing.
4. Review and analyze provider applications, documents, and data to ensure accuracy and completeness.
5. Identify and address any discrepancies or red flags in provider credentials.
6. Maintain up-to-date knowledge of credentialing regulations and requirements.
7. Build and maintain positive relationships with providers and internal teams.
8. Facilitate the onboarding and re-credentialing process for new and existing providers.
9. Assist with managing and updating provider databases and systems.
10. Document all credentialing activities and maintain accurate records.
11. Collaborate with the compliance team to identify and resolve any compliance issues related to credentialing.
12. Participate in training and development opportunities to enhance knowledge and skills in credentialing processes.
13. Proactively identify areas for process improvement and make recommendations to enhance efficiency and accuracy.
14. Adhere to all confidentiality and data security policies and procedures.
15. Collaborate with other team members to ensure consistent and efficient operations within the credentialing department.

According to JobzMall, the average salary range for a Credentialing Representative in Tampa, FL, USA is between $40,000 and $60,000 per year. This can vary depending on the specific company, experience level, and education of the individual.

UnitedHealth Group Incorporated is an American for-profit managed health care company based in Minnetonka, Minnesota. UnitedHealth Group, Inc. provides health care coverage, software and data consultancy services. It operates through the following segments: UnitedHealthcare, OptumHealth, OptumInsight, and OptumRx. The UnitedHealthcare segment utilizes Optum's capabilities to help coordinate patient care, improve affordability of medical care, analyze cost trends, manage pharmacy benefits, work with care providers more effectively, and create a simpler consumer experience.