Senior Credentialing Specialist: Compliance & Provider Ops

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

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.