Credentialing Coordinator - La Crosse, WI
Position Description
At Optum, the mission is clear: Help people live healthier lives and help make the health system work better for everyone.
LHI is one of 4 businesses under OptumServe. OptumServe provides health care services and proven expertise to help federal government agencies modernize the U.S. health system and improve the health and well - being of Americans.
By joining OptumServe you are part of the family of companies that make UnitedHealth Group a leader across most major segments in the U.S. health care system.
LHI was founded in 1999 and acquired by Optum in 2011, LHI specializes in creating and managing health care programs through on - location services, patient - specific in - clinic appointments, telehealth assessments, or any combination based on customer need. LHI's customizable solutions serve the diverse needs of commercial customers, as well as federal and state agencies, including the U.S. Departments of Defense, Veterans Affairs, and Health and Human Services.
There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Ready for a new path? Start doing your life's best work.(sm)
The Credentialing Coordinator will build and maintain a successful working relationship between LHI and network practitioner to ensure a stable practitioner network. They will be facilitating successful activation and maintenance of practitioner by performing initial credentialing, ongoing monitoring and re-credentialing process of all required network practitioners in accordance with industry standards. The Credentialing Coordinator will communicate daily with outsourced vendors, healthcare facility point of contact / professionals, as well as internal staff to maintain a detailed and compliant practitioner file credentialing system for various company contracts. As a part of the Credentialing Team, they ensure the practitioner network meets or exceeds quality, contract, and credentialing expectations to foster continued quality improvement and risk management efforts.
If you are an internal employee currently in a telecommute* role, you will have the flexibility to telecommute* as you take on some tough challenges.
Primary Responsibilities:
- Identify and document credentialing, compliance and contract requirements as the enroll in LHI's network to include creation and maintenance of practitioner record within database
- Initiate, retrieve, verify, and follow up on all credentialing applications and content needed for LHI's practitioner network. Ensure applications are complete, data integrity is intact within database to meet requirements for primary source verification
- Monitor accurate re-credentialing of practitioners on a three-year cycle
- Act as the liaison between the practitioner network and internal departments to troubleshoot issues or answer any questions/concerns
- Ongoing monitoring of credentialed network for accuracy or any change in status to include regular internal practitioner record audits
- Submit appropriate practitioner records to CVO (Certified Verification Organization). Retrieve and review CVO file as completed
- Submission of background checks as required on credentialed practitioners to contracted vendor. Retrieval and review of the reports as part of the credentialing packet
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.
Required Qualifications:
- Associate’s Degree (or higher) in Health Information Technology, Business, or related field and 1+ year experience in credentialing / healthcare – OR – a combination of college education, credentialing experience, healthcare experience, and / or military experience totaling at least 3 years
- Intermediate to Expert experience using Microsoft Office Suite including Word (ability to create, edit, save, and send documents), Excel (ability to create, edit, save, and send spreadsheets), and Outlook (ability to send / receive emails)
- 6+ months of experience using phone and computer as your primary work tools
Preferred Qualifications:
- Healthcare terminology experience
- Certified Provider Credentialing Specialist (CPCS) through the National Associate Medical Staff Services
- National Career Readiness Certificate
- Familiarity with NCQA credentialing standards
- Knowledge of practitioner credentialing and primary source verification of medical/dental licensure
- Database experience and working with electronic files / documents
Careers with LHI. Our focus is simple. We’re innovators in cost - effective health care management. And when you join our team, you’ll be a partner in impacting the lives of our customers, and employees. We’ve joined OptumHealth, part of the UnitedHealth Group family of companies, and our mission is to help the health system work better for everyone. We’re located on the banks of the beautiful Mississippi River in La Crosse, Wis., with a satellite office in Chicago and remote employees throughout the United States. We’re supported by a national network of more than 25,000 medical and dental providers. Simply put, together we work toward a healthier tomorrow for everyone. Our team members are selected for their dedication and mission - driven focus. For you, that means one incredible team and a singular opportunity to do your life’s best work.(sm)
View our COVID-19 Resources Page at: https://info.uhg.com/.
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy
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.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.