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Senior Credentialing Analyst (Enrollment and Revalidation) - Boston, MA

UnitedHealth Group

Boston, MA
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Senior Credentialing Analyst (Enrollment and Revalidation) - Boston, MA(Job Number:731359)

Here, your performance, your ideas, your unique analysis will combine with a rich assortment of contributors to understand and shape the health care system. At UnitedHealth Group, you'll work with a team that has the creativity and passion to help build new health care solutions that meet emerging market needs. You'll get the opportunity to work with an elite team that goes beyond the usual analysis, they dig deeper knowing our goal is nothing short of transforming health care. Does the challenge of utilizing your analytical abilities on vital projects towards a larger strategic mission excite you?

Massachusetts LTSS (Long Term Services & Supports) providers provide services such as home health care services, adult day health and durable medical equipment for individuals with physical, intellectual or developmental disabilities, or who need support with activities of daily living. We are serving as the state’s Third Party Administrator (TPA), providing clinical, administrative, operations and systems support for a program with $3.5 billion in annual spend. 


As a Senior Credentialing Analyst, you'll have the opportunity to provide data analysis to support, compile and report key information for operations and business objectives. This is a position that affords you the ability to drive processes and improvement initiatives. By gathering and documenting business requirements and utilizing your sharp analytical skills to fulfill the needs of the business and/or clients, you will have an impact on healing the health care system. This is a challenging role that creates an opportunity to grow and develop while doing your life's best work.(sm)


Primary Responsibilities:

  • Process Massachusetts LTSS Provider Medicaid applications, revalidations, and profile updates
  • Perform verbal, written and on-line primary source verification for individual and organizational providers, including but not limited to, state licensure, controlled substance registrations, accreditation status and exclusion database checks
  • Accurately perform data entry of all primary source verifications and select provider demographic and practice location information into Optum’s Long Term Services & Supports Management System (LTMS) & MassHealth’s MMIS System
  • Monitor work queue to ensure enrollments are processed within expected turnaround times
  • Meet or exceed production and quality standards. Perform unscheduled LTSS Provider site visits to verify compliance with regulations (60% local travel).
  • Monitor work queue to ensure enrollments are processed within expected turnaround times.
  • Gather and document business requirements from client.
  •  Create standard operating procedures (SOPs) and training documentation to support enrollment, revalidation, and update processing

Job Business Analysis
Primary Location US-MA-Boston
Other Location 
Organization Optum Corporate Administration
Schedule Full-time
Number of Openings 1
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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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