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Senior Credentialing Specialist - San Antonio, TX


Clinical Care Specialist/Staff Nurse


San Antonio, Texas, United States

Opportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind Caring. Connecting. Growing together.  

It's that time, isn't it? You're ready for the next step forward and an opportunity to build on your skills. And it just so happens that there's never been a better time to become a part of the team at UnitedHealth Group. We're 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 senior 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 5 leader.

The Senior Credentialing Specialist is responsible for processing credentialing and recredentialing 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. This role is performed onsite in an office environment in San Antonio, TX.

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
  • 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.

Required Qualifications:

  • High School Diploma or GED equivalent
  • 3+ years of administrative, database and/or data entry experience in credentialing or in a managed health care setting or related environment
  • Experience maintaining confidentiality while working with sensitive information
  • Knowledge of Microsoft Office applications with a concentration in Excel
  • Ability to work onsite in an office environment in San Antonio, TX

Preferred Qualifications:

  • CPCS Certification or willingness to pursue certification
  • 2+ years of experience in managed care credentialing operating environment
  • Proven to be detail-oriented, well-organized and ability to multi-task effectively

At 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. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. 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.

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.