Credentialing Coordinator - BioPlus Specialty Pharmacy

Carelon Employment Company LLC; Florida; Hybrid; USD 70,000 - 100,000; Full time

Job summary

Elevance Health is seeking a Credentialing Coordinator for BioPlus Specialty Pharmacy in Lake Mary, FL. The hybrid role requires 1–2 days in office weekly to support collaboration while offering work-life balance.

The position oversees credentialing activities, audits, and contract compliance, coordinating with vendors to ensure program integrity. Minimum requirements include a BA/BS and 5+ years credentialing experience; strong candidates will have credentialing certification and execution

Qualifications

• Requires a BA/BS degree and at least 5 years credentialing experience.
• Experience coordinating credentialing and re-credentialing processes.

Responsibilities

• Oversee credentialing and re-credentialing activities and audits.
• Act as liaison to delegates and credentialing vendors to ensure program compliance.
• Monitor contract compliance and coordinate changes when required.
• Coordinate and conduct initial, annual and focused audits and provide process improvements.
• Serve as corporate contact with internal partners on problems and audits.
• Provide daily oversight of credentialing operations and ensure delegation standards.

Skills

Credentialing experience

Audits

Education

BA/BS degree

Job description

Anticipated End Date: 2026-10-02 Position Title: Credentialing Coordinator - BioPlus Specialty Pharmacy 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.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and 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 and 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 candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.

Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.

NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words — the job is posted until 3/13, not through 3/13.

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.

Join our Talent Community and stay connected with company news, information, and future job opportunities. Fueled by our bold purpose to improve the health of humanity, we are transforming from a traditional health benefits organization into a lifetime trusted health partner.Our nearly 100,000 associates serve approximately 100M+ people, at every stage of health. We address a full range of needs with an integrated whole health approach, powered by industry-leading capabilities and a digital platform for health.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.

Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration

Please visit the Contract Worker Community Page. Elevance Health is an Equal Opportunity Employer/Disability/Veterans.