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: Reviews and identifies process errors in the provider set up and implementation processes or in the Issue Resolution & Service Quality (IRSQ) processes.
- Conducts procedural and departmental audits of provider data management (PDM)/credentialing set-up and contract implementation processes
- Creates and analyzes automated data quality reports to ensure accuracy of provider set-ups
- Coordinates with Internal Audit department on findings for data quality review regarding new business implementation
- Assists in identifying PDM/credentialing or IRSQ topics that require a focus group structure and conducts meetings to define best practices
- Conducts procedural and departmental process audits within IRSQ
- Creates and analyzes automated data quality reports to ensure accuracy within IRSQ
- Performs other duties as assigned
- Complies with all policies and standards
Education/Experience:
- Associate's Degree in Healthcare Administration, Business Management, related field or equivalent experience required. Bachelor's Degree in a related field preferred
- 2+ years data analysis, provider data management/credentialing, auditing, operations, or related experience required
- Knowledge of insurance or managed care products and procedures preferred
- IRSQ - Knowledge of Marketplace or No Surprises Act preferred
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
