Credentialing Coordinator - Hybrid | Compliance & Audits

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

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.