Credentialing Specialist Senior

The Elevance Health Companies, Inc.; Boght Corners (NY); Hybrid; USD 33,000 - 50,000; Full time

Benefits offered by this job

Comprehensive benefits package

401(k) with company match

Equity stock purchase program

Incentive programs

Job summary

Elevance Health, Inc. is seeking a Credentialing Specialist Senior for a hybrid role in New York. The position requires at least 4 years of credentialing experience and an HS diploma or equivalent; CPCS or CMSC are preferred.

The role involves auditing colleagues, managing credentialing documentation, and addressing complex credentialing and accreditation issues. Alternate locations may be considered if within commuting distance.

Qualifications

• Requires a HS diploma or equivalent and minimum of 4 years credentialing experience.
• CPCS or CMSC credentials preferred.

Responsibilities

• Audits work of other credentialing associates.
• Compiles and reviews documentation required by credentialing committee.
• Responds to the most complex provider credentialing, compliance and accreditation issues.
• Researches pended and probated applications and resolves discrepancies.
• Monitors reports identifying practitioners on sanctions or those who do not meet credentialing criteria for further action.
• Assists in delegation oversight and identifies on-going training needs.
• Assists in developing training materials.

Skills

Credentialing

Auditing

Research

Education

HS diploma or equivalent

Job description

Anticipated End Date: 2026-11-17

Position Title: Credentialing Specialist Senior

Credentialing Specialist Senior 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

The Credentialing Specialist Senior ensures the integrity of credentialing data and provides expertise and guidance to other credentialing associates.

How you will make an impact:

• Audits work of other credentialing associates.
• Compiles and reviews documentation required by credentialing committee.
• Responds to the most complex provider credentialing, compliance and accreditation issues.
• Researches pended and probated applications and resolves discrepancies.
• Monitors reports identifying practitioners on sanctions or those who do not meet credentialing criteria for further action and assists in researching related issues.
• May assist in delegation oversight and identifies on-going training needs.
• Assists in developing training materials.

Minimum Requirements:

• Requires a H.S. diploma or equivalent and minimum of 4 years credentialing experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• Practitioner and facility credentialing experience strongly preferred.
• Strongly preferred CPCS or CMSC.

For candidates working in person or virtually in the below locations, the salary* range for this specific position is $24.15 to $36.23

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.

Job Level: Non-Management Non-Exempt Workshift: Job Family: PND > Credentialing & Licensing

Please note 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 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.

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.

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, and 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.

Elevance Health is an Equal Opportunity Employer/Disability/Veterans.