Senior Credentialing & Provider Data Lead

Centene Corporation; Georgia; Hybrid; USD 88,000 - 158,000; Full time

Job summary

Centene Corporation is seeking a Senior Manager of Credentialing and PDM to oversee credentialing, provider data entry, enrollment, and data maintenance from triage through enrollment.

The role requires a Bachelor’s degree with 4 years of relevant experience, plus NCQA/credentialing knowledge and 3+ years of supervisory experience. Strong SQL Server skills and a deep understanding of provider data management are essential.

Qualifications

• Bachelor’s degree or equivalent experience and 4 years of relevant experience.
• NCQA, credentialing, and provider data management knowledge required.
• 3+ years of supervisory/management experience.

Responsibilities

• Lead credentialing and provider data management from triage to enrollment.
• Oversee credentialing and re-credentialing of physicians, mid-level practitioners, and organizational providers.
• Develop and manage training materials, policies, and procedures.
• Ensure provider records updates comply with policies and regulations.
• Monitor KPIs, NCQA credentialing standards, and state/federal requirements.
• Manage updates to provider directories, both hard copy and online.
• Verify accuracy of enrollment specifications and demographics.

Skills

SQL Server

Provider Data Management

Credentialing

Leadership

Education

Bachelor’s degree or equivalent experience

Tools

Portico

Amisys

CenProv

Job description

Centene Corporation is seeking a Senior Manager of Credentialing and PDM to oversee credentialing, provider data entry, enrollment, and data maintenance from triage through enrollment.

The role requires a Bachelor’s degree with 4 years of relevant experience, plus NCQA/credentialing knowledge and 3+ years of supervisory experience. Strong SQL Server skills and a deep understanding of provider data management are essential.