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Credentialing Specialist - Falls Church, VA

UnitedHealth Group

Falls Church, VA
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Job Details

741467 Credentialing Specialist Falls Church VA

Credentialing Specialist - Falls Church, VA (741467)

Position Description

The more you do, the more you learn. And as you learn you find new doors opening that challenge you to bring your best. This specialist role with UnitedHealth Group will call on your knowledge, your energy and your commitment to making health care work more effectively for more people. 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 6 leader.

Primary Responsibilities:

  • Help process provider applications and re-applications including initial mailing, review and loading into the database tracking system
  • Conduct audits and provide feedback to reduce errors and improve processes and performance

  • Demonstrate great depth of knowledge/skills in own function and act as a technical resource to others

  • Help develop credentialing policies and procedures and, occasionally, oversee primary source verification activities

  • Investigate non-standard requests and problems

  • Coordinate credentialing committee activities including arranging meetings, presenting file documentation, and keeping minutes

Get ready for some significant challenge. This is a performance driven, fast paced environment where accuracy is key. You’ll be interfacing with providers and their offices to obtain information while working within ambitious timeframes.

Required Qualifications:

  • Undergraduate degree or equivalent professional experience
  • 3+ years of experience with credentialing / re - credentialing and / or privileging in the health care industry
  • 2+ years of experience with health care accreditation and regulatory standards including NCQA requirements
  • Willingness to pursue Certified Provider Credentialing Specialist certification from the National Association of Medical Staff Services
  • Demonstrated ability to develop correspondence to facilities and clinicians
  • At least an intermediate level of proficiency with MS Excel & Word

Finding and securing the best providers for our growing networks is helping UnitedHealth Group improve the lives of millions. Join us. Learn more about how you can start doing your life’s best work.SM

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.

Key words: Managed Care, health care, credentialing, claims, provider applications, privileging, medical insurance, provider relations, medical billing


Job Details

  • Contest Number741467
  • Job TitleCredentialing Specialist - Falls Church, VA
  • Job FamilyNetwork Management
  • Business SegmentCommunity and State

Job Location Information

  • Falls Church, VA
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionNo
  • Overtime StatusNon-exempt

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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