Credentialing Manager

Centene Corporation is a leading multi-line healthcare enterprise that provides managed-care programs and related services to individuals receiving benefits under Medicaid, including Supplemental Security Income (SSI) and the State Children’s Health Insurance Program (SCHIP).Position PurposeTo perform duties to ensure the on going credentialing and re-credentialing of providers.Position Responsibilities:•Manage the credentialing department.•Responsible for Credentialing all physicians and mid-level practitioners according to Plan specifications. •Responsible for Re-credentialing all physician and mid-level providers every three years. •Manage the credentialing process for all non-delegated practitioners and providers.•Ensure compliance with National Committee for Quality Assurance (NCQA) and Department of Health and Family Services (DHFS) credentialing requirements.•Facilitate Credentialing Committee activities. •Ensure the credentialing database remains up to date and accurate.•Monitor Medicaid/Medicare sanctioning reports to ensure compliance with Health Care Financing Administration (HCFA) requirements regarding prohibition of excluded provider participation. •Monitor and track onsite physician office visits and record reviews.•Maintain secure and confidential files for each credentialed providerKnowledge/Experience: Thorough knowledge of a specialized or technical field such as management, credentialing, managed health care . Equivalent to a four (4) year college education. Over two (2) years up to and including four (4) years of management and credentialing experience. Experience in a managed care or insurance environment.4 or more years of expericence