Centene Corporation Credentialing Specialist in San Rafael, California

HourlyPosition Purpose: The Credentialing Specialist is responsible for credentialing individual, facility and/or ancillary medical/surgical providers to ensure all credentialing standards and internal requirements are met and maintained.

  • Verifies and maintains all network, individual and/or facility/ancillary providers’ information. Monitors disciplinary actions, and follows up accordingly. Corresponds with licensing board, hospitals, certification agencies, training programs and medical groups to resolve any issues.

  • Ensures and maintains overall accuracy of credentialing database. Gathers data, builds/runs reports, and sends out updates.

  • Corresponds with licensing board, hospitals, certification agencies, training programs and medical groups, practitioners, office staff, provider network administrators, contracting and management to resolve issues.

  • May review and identify credentialing or re-credentialing practitioners, including verifications of correspondence, data entry, etc., in accordance with company policies and procedures.

  • Reviews and analyzes reports, policies and procedures, summarizes, analyzes and makes notations in reports for feedback to groups and for distribution to management and Credentialing Committee.

  • Assists in the preparation of file reports and binders for monthly Credentialing Committee meetings, including pre-and post-Committee functions.

  • Assists on internal projects to obtain follow-up information as requested by Credentialing Committee or Peer Review Teams.

  • Performs other duties as assigned.

Education/Experience: High school diploma. Associate’s degree in Business Administration, Health Care Administration or related field preferred. Minimum one year credentialing experience

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.

TITLE: Credentialing Specialist

LOCATION: San Rafael, California

REQNUMBER: 1108891

COMPANY: Network Development & Contracting