Credentialing Specialist - Miami, FL - Bilingual Required
UnitedHealth Group, Miami, FL, United States
Position Summary
This position will be telecommute with occasional travel in Miami - 25%. The goals of our LTC network team are to manage and carry out the provider network requirements and all functions related to credentialing and re‑credentialing. Provider Relations experience is a plus. Microsoft Excel intermediate to advanced level is required due to the needs of network reporting. Microsoft Access basics is a plus. High school diploma required; associate degree preferred.
In this role you will be expected to:
Oversee/Facilitate/Complete receipt of provider applications
Oversee/Facilitate/Complete analysis and verification of provider credentials
Perform other assignments as required
If you are located in FL, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:
Gather and process Florida State Required (AHCA) Homelike Environment Assessments (HLEs)
Analyze and investigate
Prioritize and organize own work to meet deadlines
Provide explanations and information to others on topics within area of expertise
Apply basic knowledge of provider network functions, ability to work in a fast‑paced environment
Intermediate skill level in Microsoft programs (Outlook, Word, Excel) and spreadsheet management
Ability to take initiative and use problem‑solving skills for issue resolution
Depend minimally on others for instruction, guidance or direction. Must be attentive to detail, work with flexibility, and have the capability of multi‑tasking to meet deadlines and deliverables
Possess knowledge in Medicaid and Long‑Term Care programs and services
Must have good communication skills; and the ability to build and retain relationships with Physician or Ancillary providers
Review and process, apply functional expertise for provider/ancillary credentialing and re‑credentialing
Assist with contract management to include contract loading submissions
Display professional work ethics in a structured work environment
Perform other duties as required
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:
3+ years of experience/knowledge in the Agency for Healthcare Administration Statewide Medicaid Managed Care (SMMC) Medicaid/Long‑Term Care business
3+ years working in a network management‑related role, such as provider services, credentialing, contract processing
3+ years of experience and/or certification in ancillary credentialing, to include knowledge of credentialing requirements for the State of Florida
3+ years of experience in fee schedule management
3+ years of experience in network adequacy analysis
Proven excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
Proven intermediate level in Microsoft Word, Excel, PowerPoint, Access
Proven solid interpersonal skills, establishing rapport and working well with others
Proven solid customer service skills
Bilingual – English/Spanish
Preferred Qualifications:
English/Spanish bilingual
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Benefits and Compensation: Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401(k) contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far‑reaching choice of benefits and incentives. The hourly pay for this role will range from $28.94 to $51.63 per hour based on full‑time employment. We comply with all minimum wage laws as applicable.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug‑free workplace. Candidates are required to pass a drug test before beginning employment.
#J-18808-Ljbffr
In this role you will be expected to:
Oversee/Facilitate/Complete receipt of provider applications
Oversee/Facilitate/Complete analysis and verification of provider credentials
Perform other assignments as required
If you are located in FL, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:
Gather and process Florida State Required (AHCA) Homelike Environment Assessments (HLEs)
Analyze and investigate
Prioritize and organize own work to meet deadlines
Provide explanations and information to others on topics within area of expertise
Apply basic knowledge of provider network functions, ability to work in a fast‑paced environment
Intermediate skill level in Microsoft programs (Outlook, Word, Excel) and spreadsheet management
Ability to take initiative and use problem‑solving skills for issue resolution
Depend minimally on others for instruction, guidance or direction. Must be attentive to detail, work with flexibility, and have the capability of multi‑tasking to meet deadlines and deliverables
Possess knowledge in Medicaid and Long‑Term Care programs and services
Must have good communication skills; and the ability to build and retain relationships with Physician or Ancillary providers
Review and process, apply functional expertise for provider/ancillary credentialing and re‑credentialing
Assist with contract management to include contract loading submissions
Display professional work ethics in a structured work environment
Perform other duties as required
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:
3+ years of experience/knowledge in the Agency for Healthcare Administration Statewide Medicaid Managed Care (SMMC) Medicaid/Long‑Term Care business
3+ years working in a network management‑related role, such as provider services, credentialing, contract processing
3+ years of experience and/or certification in ancillary credentialing, to include knowledge of credentialing requirements for the State of Florida
3+ years of experience in fee schedule management
3+ years of experience in network adequacy analysis
Proven excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
Proven intermediate level in Microsoft Word, Excel, PowerPoint, Access
Proven solid interpersonal skills, establishing rapport and working well with others
Proven solid customer service skills
Bilingual – English/Spanish
Preferred Qualifications:
English/Spanish bilingual
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Benefits and Compensation: Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401(k) contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far‑reaching choice of benefits and incentives. The hourly pay for this role will range from $28.94 to $51.63 per hour based on full‑time employment. We comply with all minimum wage laws as applicable.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug‑free workplace. Candidates are required to pass a drug test before beginning employment.
#J-18808-Ljbffr