Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

Position Summary:

The Senior Enrollment and Credentialing Specialist is responsible for overseeing and executing the full cycle of provider enrollment, credentialing, and re-credentialing processes for long-term services and healthcare providers. This role ensures compliance with regulatory, accreditation, and payer requirements while maintaining accurate provider records and facilitating timely participation in insurance networks. The Senior Specialist serves as a subject matter expert, mentors’ junior staff, and partners with leadership optimize workflows, reduce turnaround times, and support organizational growth.

If you are located in reside within New England or NYS – NH, RI, CT, NYS, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Provider Enrollment & Credentialing
  • Manage the complete enrollment and credentialing process for physicians, nurse practitioners, and other long-term care providers across multiple payers and networks
  • Track application status, follow up with payers, and resolve issues to ensure timely provider participation
  • Coordinate initial credentialing, re-credentialing, and ongoing monitoring in compliance with CMS, and state requirements
  • Manage continuous credentialling and maintain accurate and up-to-date provider files, licenses, certifications, and attestations
  • Assign applications to team members, monitor status and help resolve issues
• Compliance & Quality Assurance
  • Ensure provider records meet federal, state, payer, and organizational standards
  • Conduct audits of provider files and enrollment documentation to identify gaps and ensure accuracy
  • Monitor expirable (licenses, DEA, board certifications, liability insurance) and coordinate timely renewals
  • Stay current on changes in payer regulations, credentialing standards, and industry best practices
• Collaboration & Communication
  • Serve as a primary contact between providers, internal departments, and payer representatives
  • Educate providers and staff on credentialing requirements, timelines, and documentation standards
  • Work closely with compliance, legal, and operations teams to mitigate risks related to provider credentialing and enrollment
• Leadership & Process Improvement
  • Mentor and support junior credentialing specialists, providing training and guidance
  • Recommend and implement process improvements to enhance efficiency and reduce enrollment turnaround time
  • Assist leadership in developing policies, procedures, and reporting metrics related to enrollment and credentialing

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:

• 2+ years of progressive experience in provider enrollment, credentialing, or payer relations, preferably in long-term services or post-acute care
• 2+ years of experience with Medicare, Medicaid, and commercial payer enrollment processes.
• 1+ years of experience in credentialing software
• 1+ years of experience with Excel: ability to do formulas, V look ups and pivot tables
• Proficiency with Microsoft Office Suite
• Proven exceptional organizational skills with the ability to manage multiple priorities and meet deadlines.
• Proven solid interpersonal, communication, and problem-solving skills.
• Proven detail-oriented with a high level of accuracy and accountability.
• Willingness to travel up to 25% per month for site visits

Preferred Qualifications:

• Experience with MMIS, PECOS, and payer portals
• Experience mentoring or leading a credentialing team

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

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 401k 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 salary for this role will range from$72,800 to $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes – an enterprise priority reflected in our mission.

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.