Credentialing Analyst

Elevance Health; Northern (KY); Hybrid; USD 28,000 - 52,000; Part time

Job summary

BCForward is seeking a contract credentialing specialist to support Elevance Health. You will perform credentials file audits for timeliness and documentation quality, and conduct quality reviews for Medical Director and Credentials Committee.

This role is remote with a hybrid workforce model, 9:00 am–5:00 pm CT, up to 20 hours per week; in-office presence may be required periodically. Candidates should have HS diploma and 3 years in managed care; Certified Provider Credentialing Specialist

Qualifications

• Requires HS diploma or equivalent and minimum of 3 years experience in a managed care environment.
• Certified Provider Credentialing Specialist preferred.
• Strong documentation and accuracy across credentialing processes.

Responsibilities

• Performs credentials file audits to ensure timeliness of processing, quality of documentation, and adherence to policies.
• Performs quality review of files for accuracy and completeness for Medical Director and Credentials Committee.
• Interacts with physicians and credentialing staff to obtain information and provide updates.
• Utilizes internal systems and runs reports to research provider questions and resolve issues.
• Monitors license actions, complaints, and sanctions and gathers information for Managers review.
• Prepares documentation for Medical Directors consideration of off-cycle review.

Skills

Interpersonal communication

Documentation accuracy

Data analysis

Education

HS diploma or equivalent

Certified Provider Credentialing Specialist

3 years experience in a managed care environment

Tools

Credentialing systems

Job description

Please note this is the target date and is subject to change. BCForward will send official notice ahead of a confirmed start date.

Primary duties may include, but are not limited to:

Performs credentials file audits to ensure timeliness of processing, quality of documentation, and adherence to company and department policies.

Performs quality review of files to determine accuracy and completeness of all necessary documentation for Medical Director and Credentials Committee.

Analyzes performance data to predetermined standards.

May also perform site visits of provider offices for participation in networks.

Interacts with physicians, office managers, credentialing staff from other organizations to obtain information, provide status updates, research issues necessary for Credentials Committee review.

Utilizes internal systems and runs reports/queries to research provider questions and resolve issues.

Monitors license actions, complaints, and sanctions and obtains necessary information for Managers review.

Prepares documentation for Medical Directors consideration of off-cycle review.

Maintains provider peer review information on the credentialing database system.

Supports and tracks provider appeals process.

May assume responsibility for delegation oversight activities.

Participates in accreditation survey preparation via data entry, reporting, and acting as task force liaison.

Requirements

Requires a H.S. diploma or equivalent and minimum of 3 years experience in a managed care environment; or any combination of education and experience, which would provide an equivalent background.

Strongly preferred certified Provider Credentialing Specialist and college course work.

Job Type: Contract

9a-5p CT; up to 20hrs per week and may increase over time.

Virtual, work from home

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, contractors are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must be within a reasonable commute to a PulsePoint location.

About BCForward

Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward's 6,000 consultants support more than 225 clients globally.

BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.

BCForward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.

Pay Rate Range

Min Pay Rate $19.99

Max Pay Rate $38.18

Currency USD

Unit hourly

Additional Pay Rate Notes

The pay range is the range BCForward in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations.

Benefits Information

BCForward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.

The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. This does not encompass additional non-standard compensation (e.g., benefits, paid time off, per diem, etc.).

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.