Credentialing Specialist I

Centene Corporation

2d•$19 - $33

About The Position

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. NOTE: For this role we are seeking candidates who live in North Carolina Position Purpose: Perform credentialing and related activities based on plan specifications Perform credentialing and re-credentialing activities according to plan specifications and in compliance with NCQA standards Communicate with professionalism with physicians, office managers, providers, and other third parties to secure needed information Gather information for Credentialing Committee meetings Process, track and file credentialing applications within established standards Generate and utilize reporting to support business functions Ability to thrive in a fast-paced production environment while maintaining quality

Requirements

Associate’s degree, or high school diploma/equivalent and 1+ years of data entry, customer service, medical office, provider data management, credentialing or healthcare operations (i.e. claims processing, billing, provider relations or contracting) experience, preferably in a managed care or insurance environment.

Responsibilities

Perform credentialing and related activities based on plan specifications
Perform credentialing and re-credentialing activities according to plan specifications and in compliance with NCQA standards
Communicate with professionalism with physicians, office managers, providers, and other third parties to secure needed information
Gather information for Credentialing Committee meetings
Process, track and file credentialing applications within established standards
Generate and utilize reporting to support business functions
Ability to thrive in a fast-paced production environment while maintaining quality