Sign In
 [New User? Sign Up]
Mobile Version

Credentialing Specialist - Las Vegas, NV

UnitedHealth Group

Las Vegas, NV
Job Code:
Apply on the Company Site
  • Save Ad
  • Email Friend
  • Print
  • Research Salary

Job Details

Credentialing Specialist - Las Vegas, NV(Job Number:718805)

Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.(sm)


The Credentialing Specialist is responsible for all activities associated with credentialing or re - credentialing physicians and providers. Includes processing provider applications and re - applications including initial mailing, review, and loading into the database tracking system ensuring high quality standards are maintained. Credentialing Specialists will conduct audits and provide feedback to reduce errors and improve processes and performance. Other responsibilities include the development of credentialing policies and procedures, and may oversee primary source verification activities.


Primary Responsibilities:

  • Use pertinent data and facts to identify and solve a range of problems within area of expertise
  • Investigate non - standard requests and problems, with some assistance from others
  • Work exclusively within a specific knowledge area
  • Prioritize and organize own work to meet deadlines
  • Provide explanations and information to others on topics within area of expertise
  • Design and complete data analysis projects for department customers including defining informational
  • needs, appropriate methodologies and report formats. Provide written reports with accompanying documentation of findings
  • Conducts audits of the credentialing database, confirming accurate input of provider data, including auditing other staff data entry and verifying accuracy of modifications made to the database
  • Monitor security of data within the Credentialing Database with individuals to whom data or system access may be given; report infractions to the Credentialing Supervisor
  • Maintain current knowledge of computer hardware and database software capabilities
  • Orient new staff to appropriate database use, capabilities, security, etc.
  • Act as project leader and assist in the development of provider data reporting, as requested
  • Collaborate with Information Technology to review approved software installs, upgrades, incremental backups and restorations; assist in the development of configuration documentation and updates as necessary
  • Maintain appropriate logs of database - related problems and modifications; monitor database performance and space; investigate and resolve all departmental problems, questions and concerns and make modifications, as necessary. Report all systemic database issues to Supervisor
  • Disseminate new / modified professional information to HMOs and to internal departments through the Information System Change Control Process
  • Process credentialing / re - credentialing applications accurately and promptly in accordance with internal medical group policies and procedures and NCQA standards. Coordinate the credentialing and re - credentialing processes with the Quality Improvement Department and other internal departments, as necessary
  • Prepare materials and files necessary to comply with external audits by health plans or governmental agencies
  • Accepts and performs other duties and responsibility as assigned

Job Credentialing
Primary Location US-NV-Las Vegas
Other Location 
Organization OptumCare NV
Schedule Full-time
Number of Openings 2
Apply on the Company Site

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.

Powered By

Featured Jobs[ View All ]

Featured Employers [ View All ]