Credentialing Analyst - Infusion Clinics (Hybrid)

Elevance Health; Tampa (FL); Hybrid; USD 65,000 - 95,000; Full time

Job summary

Elevance Health is seeking a Credentialing Analyst for Infusion Clinics/Nursing. The role blends in-office collaboration 1–2 days weekly with remote work flexibility within commuting distance, performing complex credentialing tasks and audits.

You will engage with physicians, office managers, and credentialing staff, manage license actions, and support accreditation processes to ensure timely, accurate credentialing operations.

Qualifications

• H.S. diploma or equivalent with minimum 3 years in a managed care environment
• Knowledge of Medicaid, Medicare, managed care, and PBM providers
• Experience administering provider/pharmacy credentialing and re-credentialing to meet regulatory and accreditation requirements
• Experience tracking, organizing, and maintaining credentialing files and time-sensitive renewals
• Certified Provider Credentialing Specialist and college coursework

Responsibilities

• 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.

Skills

Medicaid knowledge

Medicare knowledge

Managed care

PBM experience

Credentialing issues

Education

Certified Provider Credentialing Specialist

College coursework

Job description

Elevance Health is seeking a Credentialing Analyst for Infusion Clinics/Nursing. The role blends in-office collaboration 1–2 days weekly with remote work flexibility within commuting distance, performing complex credentialing tasks and audits.

You will engage with physicians, office managers, and credentialing staff, manage license actions, and support accreditation processes to ensure timely, accurate credentialing operations.