Manager, Provider Data Management & Credentialing

Centene Management Company LLC; Missouri; Hybrid; USD 88,000 - 158,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work arrangements

Job summary

Centene Management Company LLC is seeking a leader to manage credentialing and provider data management across multiple units. You will oversee credentialing, provider setup, and ensure adherence to NCQA, CMS, and DHHS standards while collaborating with plans and departments on initiatives.

The role requires guiding cross-functional teams on large projects, driving process improvements, and ensuring accurate staff performance and training.

Qualifications

• Bachelor’s degree in related field or equivalent experience.
• 5+ years of combined management and provider data management, credentialing or healthcare operations experience.
• Experience as a lead managing cross functional teams on large scale projects or supervising staff.

Responsibilities

• Oversee credentialing and re-credentialing of physicians, mid-level practitioners and organizational providers.
• Ensure provider data management and setup processes for claims payment and directory display.
• Ensure compliance with NCQA, CMS, DHHS and other regulatory standards; participate in accreditation activities.
• Identify opportunities to improve cost, quality and efficiency; monitor regulatory sanction reports.

Skills

Cross-functional leadership

Project management

Regulatory compliance knowledge

Education

Bachelor's degree or equivalent experience

Job description

Position Purpose: Manage the operations of all credentialing and provider data management functions for multiple business units ensuring compliance with National Committee for Quality Assurance (NCQA), Department of Health and Human Services (DHHS), Center of Medicaid/Medicare Services (CMS) and other regulatory standards. Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT. Oversee the credentialing and re-credentialing of all physicians, mid-level practitioners and organizational providers according to the plan specifications for multiple business units. Oversee the provider setup processes ensuring accurately and timely setup for claims payment, member assignment and directory display. Ensure compliance with NCQA and DHHS credentialing requirements and participate in activities related to plan NCQA accreditation. Collaborate with the health plans and various departments on network expansion efforts, large claims and contract amendment projects and various related initiatives. Identify process improvement opportunities to decrease cost, improve quality and increase efficiency within the department. Review and update departmental policies and procedures to ensure compliance with NCQA, CMS and other regulatory agencies. Monitor Medicaid and Medicare sanctioning reports to ensure compliance with Health Care Financing Administration (HCFA) requirements regarding prohibition of excluded provider participation. Facilitate Credentialing Committee activities and serve on Quality Improvement Committees, when needed.

Education / Experience

• Bachelor’s degree in related field or equivalent experience.
• 5+ years of combined management and 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.
• Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.

Pay Range

$87,700.00 - $157,800.00 per year

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.

Benefits and Compensation

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

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

Thanks for your interest in Centene and its subsidiary companies. We're so glad that you've decided to fill out an application and take the next step to find your purpose.

Also, we're here to help support you on your candidate journey. Should you need an accommodation, please email [e-mail].

We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well.