Senior Manager, Credentialing & Provider Data Systems

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

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Job summary

Centene Corporation is seeking a Senior Manager of Credentialing and Provider Data Management to oversee credentialing and provider data entry from triage through enrollment and ongoing maintenance. The role requires a strong technical background and leadership of a technical team.

Responsibilities include direct oversight of credentialing and re-credentialing for physicians and providers, management of provider data policies, and ensuring compliance with NCQA and state/federal requirements.

Qualifications

• Bachelor’s degree or equivalent experience; NCQA credentialing knowledge required.
• 3+ years supervisory/management experience.

Responsibilities

• Lead a team supporting credentialing and provider data management from a technical perspective including system updates, data analysis, and reporting.
• Direct oversight for credentialing and re-credentialing of physicians, mid-level practitioners and organizational providers.
• Oversee all activities related to provider data management including training materials, policies, and procedures.
• Ensure updates for provider records in line with health plan policies and state/federal regulations.
• Ensure compliance with KPIs, NCQA credentialing standards and state/federal requirements.
• Manage updates to and production of provider directories.
• Ensure accuracy of provider enrollment specifications and demographics.

Skills

SQL Server

Provider data management

Credentialing

Leadership

Technical team leadership

Education

Bachelor's degree or equivalent experience

NCQA credentialing knowledge

Tools

Portico

Amisys

CenProv

Job description

Centene Corporation is seeking a Senior Manager of Credentialing and Provider Data Management to oversee credentialing and provider data entry from triage through enrollment and ongoing maintenance. The role requires a strong technical background and leadership of a technical team.

Responsibilities include direct oversight of credentialing and re-credentialing for physicians and providers, management of provider data policies, and ensuring compliance with NCQA and state/federal requirements.