Credentialing Coordinator - BioPlus Specialty Pharmacy

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

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.

The Credentialing Coordinator coordinates and leads credentialing program-level compliance activities for the sanction monitoring program, delegation oversight audits and/or regulatory and compliance audits.

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.

#EHS

#LI

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

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 Accessibility Accommodation Request Form (https://forms.cloud.microsoft/pages/responsepage.aspx?id=8giMvgesLESaRuvu61vU17EJaA0EP3FIissI8zmZ_NpUNUgyTFRUMkY5NE5JNDFWMkhaUzQxMkJLWS4u&route=shorturl) 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 (https://info.flclearinghouse.com/).