Credentialing Specialist I

Centene Corporation•Remote-NC, NV

5d•$19 - $33•Remote

About The Position

Perform credentialing and related activities based on plan specifications. This fully remote role is open to candidates nationwide. The specialist performs credentialing and re-credentialing activities in compliance with NCQA standards, communicates with physicians, office managers, providers, and third parties to secure information, gathers information for Credentialing Committee meetings, processes and tracks credentialing applications, and generates reports to support business functions. The position requires working effectively in a fast-paced production environment while maintaining quality, and includes performing primary source verification (PSV) for education verification.

Requirements

Associate’s degree, or high school diploma/equivalent and at least 1 year of experience in data entry, customer service, a medical office, provider data management, credentialing, or healthcare operations such as claims processing, billing, provider relations, or contracting.
Ability to thrive in a fast-paced production environment while maintaining quality.

Nice To Haves

Experience in a managed care or insurance environment is preferred.
Ability to perform primary source verification (PSV) for education verification is strongly preferred.

Responsibilities

Perform credentialing and re-credentialing activities according to plan specifications and in compliance with NCQA standards.
Communicate professionally 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 use reporting to support business functions.
Perform primary source verification (PSV) for education verification.