Director, Provider Data & Credentialing Operations

Centene Corp.; Northern (KY); Hybrid; USD 88,000 - 158,000; Full time

Job summary

Centene Corp. seeks a senior leader to manage credentialing and provider data management across multiple business units.

You will ensure NCQA, DHHS and CMS compliance, oversee provider setup for claims and directory display, and drive cross-functional initiatives in network expansion and contract amendments. You will lead a team, monitor sanctions, review policies, and participate in quality improvement activities to raise efficiency and reduce costs.

Qualifications

• Bachelor’s degree or equivalent experience required.
• 5+ years of combined management and provider data management, credentialing, or healthcare operations experience.
• Leadership experience with cross-functional teams on large projects.
• Experience in managed care or insurance environments preferred.

Responsibilities

• Oversee credentialing and re-credentialing of physicians, mid-level practitioners, and organizational providers across multiple units.
• Oversee provider setup processes for accurate, timely claims payment, member assignment, and directory display.
• Ensure NCQA, DHHS, CMS and other regulatory compliance in credentialing activities.
• Collaborate with health plans and departments on network expansion, large claims, and contract amendments.
• Identify opportunities to reduce costs, improve quality, and increase department efficiency.
• Review and update departmental policies to meet NCQA, CMS, HCFA regulations.
• Monitor Medicaid and Medicare sanctioning reports for compliance.
• Facilitate Credentialing Committee activities and participate in Quality Improvement Committees as needed.

Skills

Credentialing leadership

Regulatory compliance

Process improvement

Cross-functional collaboration

Staff supervision

Education

Bachelor’s degree

Job description

Centene Corp. seeks a senior leader to manage credentialing and provider data management across multiple business units.

You will ensure NCQA, DHHS and CMS compliance, oversee provider setup for claims and directory display, and drive cross-functional initiatives in network expansion and contract amendments. You will lead a team, monitor sanctions, review policies, and participate in quality improvement activities to raise efficiency and reduce costs.