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Provider Enrollment Representative - Franklin, TN

UnitedHealth Group

Franklin, TN
Job Code:
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Job Details

Provider Enrollment Representative - Franklin, TN(Job Number:707262)

Position Description:

Energize your career with one of Healthcare’s fastest growing companies.  


You dream of a great career with a great company – where you can make an impact and help people.  We dream of giving you the opportunity to do just this.  And with the incredible growth of our business, it’s a dream that definitely can come true. Already one of the world’s leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives.  We live for the opportunity to make a difference and right now, we are living it up.


This opportunity is with one of our most exciting business areas: Optum –a growing part of our family of companies that make UnitedHealth Group a Fortune 17 leader.


Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.

The Provider Enrollment Representative is a part of a team who is responsible for the oversight of enrollment and revalidation enrollment of OptumCare Allied Health Professional and Physician providers in more than 43 states. Enrollment functions include, but are not limited to, understanding of Center for Medicare Services (CMS) guidelines, Federal and State regulations & requirements, regularly participate with internal and external audits, understanding and operation of Council for Affordable Quality Healthcare (CAQH) ProView Portal, PECOS, collaborate with practitioners to prepare paper and electronic applications for submission to Medicare/Medicaid and various commercial payers expeditiously, maintain delegated health plan rosters on set schedule, setup/maintain group enrollments, setup/maintain group NPI’s, maintenance of practice locations, and maintenance of Tax ID’s. Proficient in performing job functions with minimal tutoring.

Primary Responsibilities:
  • Generate, complete, and submit applications for new and established enrollments with Medicare, Medicaid, and various other Commercial Plans
  • Meticulously review documents prior to transmission of applications via UPS and/or email to providers and health plans
  • Data entry and maintenance into Vistar (eVIP) database in accordance with internal policies and procedures with high‐level accuracy
  • Maintain assigned market/region in all aspects of provider enrollment
  • Apply knowledge/skills to complex activities
  • Provide feedback to reduce errors and improve processes
  • Develop and maintain relationships with market leadership
  • Anticipate customer needs and proactively identify solutions
  • Independently and as a team solve complex problems
  • Prioritize work tasks independently
  • Participate with internal and external audits
  • Provide exceptional customer service to our internal and external contacts
  • Ability to work independently with minimal supervision
  • Adapt well in a changing environment

Job Credentialing
Primary Location US-TN-Franklin
Other Location 
Organization Complex Care Management
Schedule Full-time
Number of Openings 1
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.

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