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Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together .

The Business Operations Specialist is responsible for all activities associated with Insurance Payer credentialing for physicians and other qualified health care providers. This includes credentialing and re-credentialing of providers and clinic locations with Federal/State organizations (Medicare/Medicaid) as well as contracted managed care payers. This also includes maintenance of all current provider enrollments, updating all database tracking systems, and quality assurance activities to ensure accuracy, compliance, and improve processes and performance.

You'll enjoy the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

• Complete 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

• Re-credential providers via CAQH every 120 days to ensure provider credentialing statuses remain consistent

• Coordinate with BCH Medical Staff Office to ensure all applicable documents are acquired for timely credentialing of providers

• Communicate with representatives from managed care organizations and the BVIPA to update physician roster lists when appropriate

• Update and communicate provider credentialing status when employment termination occurs

• When necessary, work collaboratively with hospital reimbursement specialists to update Medicare 855A forms

• Maintain and update Medicare 855B enrollment for CMA group locations and providers

• Update Provider Enrollment, Chain and Ownership System (PECOS) and National Plan & Provider Enumeration System (NPPES) when appropriate

• Set meetings with providers to complete necessary credentialing paperwork or acquire necessary signatures when needed

• Maintain the confidentiality of all verbal and written communications and all collected data, as appropriate

• Serve as an educational resource to providers and staff concerning credentialing activities

• Serve as the primary liaison between billing staff and payers when reimbursement issues arise due to credentialing activities

• Update and maintain timely credentialing matrix for providers and staff to have an accurate picture of current credentialing activities and status

• Communicate with IT analysts and Billing Office staff when provider statuses change in order to facilitate correct billing.

• Creates ad hoc reports upon request from Director of Physician Revenue Cycle, Physician Billing Manager, Compliance Department, or Medical Staff Department

• Participate in department and hospital committees/projects as needed/requested

• Attend appropriate continuing education seminars

• Meet monthly with Director of Physician Revenue Cycle and Physician Clinics Billing Manager to give updates on credentialing activities

• Maintain consistent and on time attendance; this is an essential component of the position

• Comply with all regulatory requirements, including Joint Commission Standards

• Performs other duties as assigned

What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays

• Medical Plan options along with participation in a Health Spending Account or a Health Saving account

• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage

• 401(k) Savings Plan, Employee Stock Purchase Plan

• Education Reimbursement

• Employee Discounts

• Employee Assistance Program

• Employee Referral Bonus Program

• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

• More information can be downloaded at: http://uhg.hr/uhgbenefits

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 / GED (or higher)

• 2+years of experience withphysician and/or hospital billing or payer credentialing

• Intermediate proficiency in Microsoft Office Suite Products (e.g Word, Excel, PowerPoint, Outlook, etc.)

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island, Hawaii, Washington, or Washington D.C Residents Only: The hourly range for California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island, Hawaii, Washington, or Washington D.C residents is $16.00 to $28.27 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.

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