Credentialing Specialist I

Centene; United States; Remote; USD 27,000 - 45,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off + holidays

Remote work with flexible schedules

Job summary

Centene is looking for a Credentialing Specialist to perform credentialing and re-credentialing activities according to plan specifications and NCQA standards. You will communicate with physicians, office managers, providers, and other third parties to secure needed information and gather data for Credentialing Committee meetings.

This fully remote role is open to candidates nationwide. The position requires experience in data entry, provider data management, and healthcare operations, with PSV

Qualifications

• Experience in credentialing or healthcare operations preferred.
• Ability to perform PSV for education verification.
• Experience with data entry and provider data management systems.

Responsibilities

• Perform credentialing and re-credentialing activities per plan and NCQA standards.
• Communicate professionally with physicians, office managers, providers and third parties.
• Gather information for Credentialing Committee meetings.
• Process, track and file credentialing applications within standards.
• Generate and utilize reporting to support business functions.
• Thrive in a fast-paced production environment while maintaining quality.
• Ability to perform PSV for education verification.

Skills

Data entry

Customer service

Medical office

Provider data management

Credentialing

Healthcare operations

Education verification PSV

Education

Associate's degree or HS diploma + 1+ years experience

Job description

Position Purpose:

• 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
• Ability to perform PSV for education verification

Key Details:

This is a fully remote role and is open to candidates nationwide.

Education/Experience:

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. Ability to perform PSV for education verification is strongly preferred.

Pay Range:

$19.43 - $32.98 per hour

Centene Overview and Benefits:

At Centene, we connect people to the care they need to live healthier lives - and the work you do here makes that impact real every day. You'll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It's work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Centene offers a comprehensive benefits package including:

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• a flexible approach to work with remote, hybrid, field or office work schedules

Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law , including full-time or part-time status. Total compensation may also include additional forms of incentives.

Benefits may be subject to program eligibility.

Equal Opportunity Employment:

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Additional Eligibility:

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act