Job Description

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. **Position Purpose:** The Credentialing Specialist Lead interacts with associates and current/potential providers. The Lead provides information to internal and field staff about network credentialing policies, procedures and processes and serves as the primary resource for the credentialing database and system. The Lead researches unresolved or complex issues, compiles necessary information, and forwards data to appropriate staff members for resolution. The lead credentials individual and/or facility & ancillary medical/surgical providers to ensure all credentialing standards and internal requirements are met and maintained. The Lead is the primary person for questions for department staff. The lead assists in administering daily staff activity, enforcing operational standards, maintaining associate productivity levels, improving quality service, preparing reports, maintaining professional and technical knowledge, and accomplishing organizational goals. + Performs primary source verification and maintains a record of the network's individual and/or facility/ancillary providers' information according to credentialing standards of all state and federal regulatory entities including all medical and surgical provider types. + Assists department supervisor with assigning and auditing work, scheduling and managing staff. Serves as escalation point for questions and issues from credentialing staff. + Primary lead for Ongoing Sanctions Monitoring process, i.e. CAQH, DHHS and Medical Board disciplinary actions, and follows up accordingly. + Corresponds with licensing board, NPDB, hospitals, certification agencies, training programs and medical groups to resolve any issues. + Drafts summary of sanctions for Medical Director review. + Assists with internal projects by obtaining follow-up information, gathering data, building/running reports, and distributing updates. + Trains new associates on departmental systems, processes, policies and procedures. + Reviews and recommends changes to departmental policies, procedures and desktop procedures. + Communicates with providers, groups, and company peers to maintain overall contractual compliance. + Responsible for overall accuracy of credentialing database, assuring that the information is current and that information is presented internally and externally in a timely and professional manner. + Other duties as assigned. **Education/Experience:** High school diploma or GED; Associate's Degree in related field preferred. Minimum three years credentialing experience. Previous Lead/Supervisory experience preferredPay Range: $22.79 - $38.84 per hour 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

Job Tags

Hourly pay, Full time, Part time, Work at office, Remote work, Flexible hours,

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