Credentialing Specialist I

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
 

Credentialing Providers to ensure accurate and timely credentialing of new providers into the Fidelis Care network, following all compliance and regulatory standards.
Recredentialing Existing Providers. Manage the recredentialing process for providers already in the network to maintain quality and compliance.

Position Purpose:
Assist the plan in credentialing and re-credentialing providers.

• Credential and re-credential various providers, including physicians, healthcare delivery organizations, or pharmacies, according to applicable specifications
• Maintain and update credentialing database
• Assist with coordinating credentialing committee
• Process, track and file credentialing applications within established standards
• Respond to internal and external customer inquiries regarding credentialing status
• May require the ability to travel, a valid driver’s license, and car insurance (depending on business unit)
• Performs other duties as assigned
• Complies with all policies and standards

SKILLS & EXPERIENCE

Provider Credentialing

Member Services/Success

Claims Processing

* Highly Preferred ~ Medicare/Medicaid experience

90% Remote

10% Travel for in office meetings/training

* NY Residents Highly Preferred

EST and CST residents preferred

Education/Experience:
High school diploma or equivalent. 2+ years of credentialing or provider data experience.
 

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  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.

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