Senior Credentialing Specialist

Centrum Health; Florida; On-site; USD 55,000 - 75,000; Full time

Job summary

Centrum Health, a NeueHealth company, seeks a Senior Credentialing Representative to assist day-to-day credentialing activities for providers across our network. You will help obtain documentation, maintain records, and ensure compliance with state, federal, and URAC guidelines, while collaborating with internal teams and external vendors.

The role emphasizes accuracy, timely communication with providers, and supporting the overall credentialing program within our clinics and partnerships.

Qualifications

• High school diploma or GED required; associate or bachelor's preferred.
• Three or more years of credentialing experience.
• Proficiency with Microsoft Office, especially Excel; credentialing software a plus.
• Ability to manage detailed information accurately and ensure compliance with standards.

Responsibilities

• Assist in executing key components of the credentialing process.
• Review and process credentialing applications and maintain files.
• Track application status and obtain missing documentation from providers.
• Ensure credentialing activities comply with policies, state/federal regulations, and URAC.
• Maintain up-to-date credentialing records and documentation.
• Prepare and submit credentialing files for review (clean and risk files).
• Communicate status to providers and provide guidance on the process.
• Send out determination letters based on Credentialing Committee decisions.
• Provide admin support by managing file feeds and updating systems.
• Maintain provider manuals and credentialing resources.
• Collaborate with internal teams on cross-functional initiatives.
• Perform other related tasks to support the program.

Skills

Detail-oriented

Communication skills

Independent work

Cross-functional teamwork

Analytical skills

Education

High school diploma or GED

Associate's or Bachelor's degree preferred

Tools

Microsoft Office (Excel)

Credentialing software

Job description

NeueHealth is a value-driven healthcare company grounded in the belief that all health consumers are entitled to high-quality, coordinated care. By uniquely aligning the interests of health consumers, providers, and payors, we help to make healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid.

NeueHealth delivers clinical care to health consumers through our owned clinics – Centrum Health and Premier Medical – as well as unique partnerships with affiliated providers across the country. We also enable providers to succeed in performance-based arrangements through a suite of technology and services scaled centrally and deployed locally. Through our value-driven, consumer-centric approach, we are committed to transforming healthcare and creating a better care experience for all.

JOB SUMMARY

The Senior Credentialing Representative is responsible for assisting with the day-to-day execution of the provider credentialing process, ensuring that all providers meet necessary requirements and compliance standards. This role involves working closely with providers to obtain necessary documentation, maintaining credentialing records, and ensuring the credentialing process is completed in accordance with state, federal, and regulatory guidelines. The Senior Credentialing Representative supports the overall credentialing program and works collaboratively with internal teams and external vendors.

DUTIES & RESPONSIBILITIES

• The Senior Credentialing Representative job description is intended to point out major responsibilities within the role, but it is not limited to these items.
• Assist in executing key components of the credentialing process, including reviewing and processing credentialing applications, maintaining credentialing files, and tracking application status.
• Work with providers to obtain missing documentation or information required for the credentialing process.
• Ensure that all credentialing activities adhere to company policies, state and federal regulations, and URAC requirements.
• Maintain up-to-date records and credentialing documentation for all providers, ensuring accuracy and completeness.
• Assist in preparing and submitting credentialing files for review, including both clean and risk files.
• Communicate with providers regarding the status of their credentialing applications, gathering additional information as needed and providing guidance on the credentialing process.
• Send out determination letters based on the Credentialing Committee’s decisions.
• Provide administrative support by managing credentialing file feeds, updating credentialing systems, and maintaining provider tools as required.
• Assist in maintaining provider manuals and other credentialing resources.
• Collaborate with internal teams and participate in cross-functional initiatives to ensure smooth credentialing operations.
• Perform other related tasks and responsibilities as assigned to support the overall credentialing program.

EDUCATION AND PROFESSIONAL EXPERIENCE

• High School diploma or GED required; Associate's degree or Bachelor’s degree in healthcare administration or related field preferred.
• Three (3) or more years of experience in credentialing, managed care, or a related healthcare field.
• Proficiency with Microsoft Office, particularly Excel. Experience with credentialing software is a plus.

PROFESSIONAL COMPETENCIES

• Proven ability to manage detailed information accurately and ensure compliance with standards and guidelines.
• Strong verbal and written communication skills for interacting with providers and internal teams.
• Ability to manage multiple tasks and prioritize workloads to meet deadlines.
• Capable of working independently as well as collaborating effectively within cross-functional teams.
• Strong analytical skills to assess credentialing issues and take corrective actions where needed.

As an Equal Opportunity Employer, we welcome and employ a diverse employee group committed to meeting the needs of NeueHealth, our consumers, and the communities we serve. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

As set forth in Centrum Health’s Equal Employment Opportunity policy,we do not discriminate on the basis of any protected group status under any applicable law.

Voluntary Self-Identification

For government reporting purposes, we ask candidates to respond to the below self-identification survey.Completion of the form is entirely voluntary. Whatever your decision, it will not be considered in the hiringprocess or thereafter. Any information that you do provide will be recorded and maintained in aconfidential file.

As set forth in Centrum Health’s Equal Employment Opportunity policy,we do not discriminate on the basis of any protected group status under any applicable law.

If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection.As a government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), we request this information in order to measurethe effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Classification of protected categoriesis as follows:

A "disabled veteran" is one of the following: a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service-connected disability.

A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.

An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.

An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.