Credentialing Specialist

Elevance Health, Inc.; Latham (NY); Hybrid; USD 28,000 - 43,000; Full time

Job summary

Elevance Health, Inc. in New York seeks a Credentialing Specialist to build provider credentialing files and determine eligibility based on general guidelines, ensuring compliance with internal policies and external regulatory agencies.

Responsibilities include receiving provider applications, gathering documentation, preparing for credentialing committee review, and addressing discrepancies while coordinating with senior staff as needed. Hybrid/office optional per policy.

Qualifications

• Must have high school diploma or equivalent and at least 1 year credentialing experience.
• Experience with provider credentialing processes preferred.
• Ability to interpret guidelines and apply regulatory requirements.

Responsibilities

• Receives provider applications and contacts providers for additional documentation or clarification.
• Builds file documentation and prepares file for credentialing committee review.
• Applies guidelines to determine whether provider meets criteria and documents deficiencies.
• Prepares correspondence to providers regarding status.
• Assists in researching pended and probated applications and resolving discrepancies.
• Refers non-approved providers or questionable situations to senior representative.
• May assist in provider education and preparation of training materials.

Skills

Credentialing basics

Documentation

Education

High school diploma or equivalent

1 year credentialing experience

Job description

Hybrid 1: 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.

Credentialing Specialist builds provider credentials file and makes file determinations regarding required credentialing criteria based on general guidelines, ensuring compliance with internal policies and external regulatory agencies.

How You Will Make An Impact

• Receives provider applications and contacts providers for any additional supporting documentation or clarification.
• Builds file documentation and prepares file for credentialing committee review.
• Applies general guidelines in determining whether provider meets criteria and documents deficiencies.
• Prepares correspondence to providers regarding status.
• Assists in researching pended and probated applications and resolving discrepancies.
• Refers non-approved providers or questionable situations to senior representative.
• May assist in provider education and preparation of provider training materials.

Minimum Requirements

• Requires high school diploma or equivalent; minimum of 1 years credentialing or related experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities And Experiences

• Practitioner and facility credentialing strongly preferred.

For candidates working in person or virtually in the below locations, the salary* range for this specific position is $20.60 to $30.90

Location(s): New York

In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

• The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.