Credentialing & Compliance Lead (Hybrid)

Elevance Health; Miami (FL); Hybrid; USD 60,000 - 90,000; Full time

Job summary

Elevance Health is seeking a Credentialing Coordinator in Lake Mary, FL. This hybrid role requires in-office presence 1-2 days per week to foster collaboration while offering flexibility for productive work-life balance.

Candidates outside commuting distance may be considered with accommodations. You will lead program-level credentialing and re-credentialing activities, coordinate audits, manage contracted organizations, and serve as a liaison with delegates and vendors to ensure compliance and

Qualifications

• BA/BS degree in a related field and 5+ years credentialing experience.
• Equivalent combination of education and experience acceptable.

Responsibilities

• Oversee credentialing and re-credentialing activities, including audits.
• Manage contracts and account relationships with organizations.
• Coordinate with delegates and credentialing vendors to ensure compliance.
• Monitor contracts and coordinate language changes when needed.
• Coordinate and conduct credentialing audits and department reviews.
• Provide process improvements and performance feedback.
• Resolve issues related to delegation oversight, sanction monitoring, and policy reviews.
• Serve as liaison with internal partners on regulatory audits.
• Oversee daily operations for resolving non-responsive providers.
• Maintain credentialing standards and business requirements.
• Research and resolve credentialing issues.
• Provide recommendations to committee on processes.
• Review Health Plan elements in Credentialing Manual and update docs.
• Lead special projects.

Skills

Credentialing

Audits

Vendor coordination

Account management

Education

BA/BS degree

Job description

Elevance Health is seeking a Credentialing Coordinator in Lake Mary, FL. This hybrid role requires in-office presence 1-2 days per week to foster collaboration while offering flexibility for productive work-life balance.

Candidates outside commuting distance may be considered with accommodations. You will lead program-level credentialing and re-credentialing activities, coordinate audits, manage contracted organizations, and serve as a liaison with delegates and vendors to ensure compliance and