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Manager, Provider Data Management – Credentialing
Centene Corporation. Manage operations of credentialing and provider data management functions for multiple business units .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in managing credentialing and provider data management operations, ensuring compliance with NCQA, DHHS, and CMS standards while leading cross-functional teams to improve efficiency and quality in healthcare operations.
Highest-signal resume keywords
Credentialing ManagementProvider Data ManagementRegulatory ComplianceHealthcare Operations ExperienceSupervisory Experience
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
CredentialingRe-CredentialingProvider Setup ProcessesClaims PaymentMember AssignmentDirectory DisplayProcess ImprovementPolicy ReviewSanction MonitoringQuality Improvement
Soft Skills
CollaborationLeadershipTrainingPerformance Management
Industry Keywords
NCQADHHSCMSManaged CareInsurance EnvironmentMedicaidMedicareHCFA
About the role
Key responsibilities & impact- Manage operations of credentialing and provider data management functions for multiple business units
- Oversee credentialing and re-credentialing of physicians, mid-level practitioners and organizational providers
- Oversee provider setup processes for claims payment, member assignment and directory display
- Ensure compliance with NCQA and DHHS credentialing requirements
- Participate in activities related to plan NCQA accreditation
- Collaborate with health plans and departments on network expansion, large claims, contract amendment projects and related initiatives
- Identify process improvement opportunities to decrease cost, improve quality and increase efficiency
- Review and update departmental policies and procedures for compliance with NCQA, CMS and other regulatory agencies
- Monitor Medicaid and Medicare sanctioning reports for compliance with HCFA requirements
- Facilitate Credentialing Committee activities
- Serve on Quality Improvement Committees when needed
Requirements
What you’ll need- Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future
- Bachelor’s degree in related field or equivalent experience
- 5+ years of combined management and provider data management, credentialing or healthcare operations experience
- Experience preferably in a managed care or insurance environment
- Previous experience as a lead in a functional area, managing cross functional teams on large scale projects, or supervisory experience
- Supervisory experience including hiring, training, assigning work and managing staff performance
- Knowledge of NCQA, DHHS, CMS and other regulatory standards
- Experience with physician, mid-level practitioner and organizational provider credentialing and re-credentialing
- Experience with provider setup processes for claims payment, member assignment and directory display
- Experience monitoring Medicaid and Medicare sanctioning reports and HCFA requirements
Benefits
Comp & perks- Competitive pay
- Health insurance
- 401K
- Stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- Flexible approach to work with remote, hybrid, field or office work schedules
- Additional forms of incentives may be included in total compensation
- Equal opportunity employer committed to diversity