Credentialing Coordinator - BioPlus Specialty Pharmacy

Elevance Health (Anthem); Florida; Hybrid; USD 60,000 - 75,000; Full time

Job summary

Elevance Health in Lake Mary, FL, is seeking a Credentialing Coordinator to oversee credentialing and re-credentialing programs, manage contracted organizations, and coordinate audits. Hybrid work requires 1–2 days in office weekly, with potential alternate locations for commuting candidates.

The role emphasizes coordination with delegates and credentialing vendors, ensuring program compliance, and driving process improvements across credentialing operations.

Qualifications

• Requires a BA/BS degree in a related field and minimum 5 years credentialing experience; or any combination of education and experience, which would provide an equivalent background.
• Strongly preferred credentialing certification.

Responsibilities

• Performs oversight of credentialing and re-credentialing activities and processes, including internal and external audits.
• Responsible for account management of contracted organizations.
• Acts as a liaison to delegates and credentialing vendors to ensure that credentialing program compliance requirements are maintained.
• Monitor contract compliance and coordinates/negotiates contractual language changes when required.
• Coordinates all compliance filings of credentialing specific documents and policies.
• Coordinates and conducts initial, annual and focused audits, including vendor and/or delegation oversight, or department audits.
• Provides feedback and recommendations to improve processes and performance.
• Resolves issues independently specific to delegation oversight, sanction monitoring, validation, notification, system configuration and reporting, and credentialing policy and procedural reviews and exceptions.
• Serves as corporate contact and interface with internal business partners on problems, resolutions, questions, and regulatory or accreditation audits.
• Provides process oversight of daily business operations as it relates to resolution of non-responsive providers to credentialing and re-credentialing.
• Maintains delegation/credentialing standards and business requirements.
• Researches and resolves delegated credentialing-related issues.
• Provides recommendations to committee on process administration.
• Reviews assigned Health Plan elements in Credentialing Manual and provides updates as appropriate regarding new or improved documentation resources and business rules.
• Leads special projects.

Skills

Credentialing

Auditing

Vendor liaison

Compliance

Education

BA/BS degree

Job description

Credentialing Coordinator

Primary Location(s): Lake Mary, FL

Hybrid: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

How You Will Make an Impact

• Performs oversight of credentialing and re-credentialing activities and processes, including internal and external audits.
• Responsible for account management of contracted organizations.
• Acts as a liaison to delegates and credentialing vendors to ensure that credentialing program compliance requirements are maintained.
• Monitor contract compliance and coordinates/negotiates contractual language changes when required.
• Coordinates all compliance filings of credentialing specific documents and policies.
• Coordinates and conducts initial, annual and focused (corrective action plan) audits, including vendor and/or delegation oversight, or department audits.
• Provides feedback and recommendations to improve processes and performance.
• Resolves issues independently specific to delegation oversight, sanction monitoring, validation, notification, system configuration and reporting, and credentialing policy and procedural reviews and exceptions.
• Serves as corporate contact and interface with internal business partners on problems, resolutions, questions, and regulatory or accreditation audits.
• Provides process oversight of daily business operations as it relates to resolution of non-responsive providers to credentialing and re-credentialing.
• Maintains delegation/credentialing standards and business requirements.
• Researches and resolves delegated credentialing-related issues.
• Provides recommendations to committee on process administration.
• Reviews assigned Health Plan elements in Credentialing Manual and provides updates as appropriate regarding new or improved documentation resources and business rules.
• Leads special projects.

Minimum Requirements

• Requires a BA/BS degree in a related field and minimum 5 years credentialing experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences

• Strongly preferred credentialing certification.
• #ELH
• #LI

Job Level: Non-Management Non-Exempt

Workshift:

Job Family: PND > Credentialing & Licensing

Who We Are

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.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

Benefits

• merit increases
• paid holidays
• Paid Time Off
• incentive bonus programs (unless covered by a collective bargaining agreement)
• medical
• dental
• vision
• short and long term disability benefits
• 401(k) +match
• stock purchase plan
• life insurance
• wellness programs
• financial education resources
• to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates 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.

The health of our associates and communities is a top priority for Elevance Health. We require all new candi