Hybrid Credentialing Analyst, Infusion Clinics

Elevance Health; Florida; Hybrid; USD 60,000 - 80,000; Full time

Job summary

Elevance Health is seeking a Credentialing Analyst to support infusion clinics and nursing credentialing with hybrid in-office requirements. The role involves audits, file reviews, performance analysis, and engaging with physicians and credentialing staff to resolve issues.

The position emphasizes regulatory compliance, network participation, and accreditation readiness, with a strong workflow in credentialing operations and data management.

Qualifications

• Requires a high school diploma or equivalent and at least 3 years in a managed care environment or equivalent background.
• Preferred Certified Provider Credentialing Specialist certification and related coursework.
• Experience handling credentialing files, renewals, and regulatory requirements.

Responsibilities

• Performs credentials file audits for timeliness, quality, and policy adherence.
• Reviews files for accuracy and completeness for Medical Director and Credentials Committee.
• Analyzes performance data to standards.
• May perform site visits to provider offices for network participation.
• Interacts with physicians, office managers, and credentialing staff to obtain information.
• Uses internal systems and runs reports to resolve credentialing questions.
• Monitors license actions, complaints, and sanctions for Manager review.
• Prepares documentation for Medical Directors' off-cycle reviews.
• Maintains provider peer review data in the credentialing database.
• Supports and tracks provider appeals process.
• May oversee delegation activities.
• Participates in accreditation survey prep via data entry and reporting.

Skills

Credentialing audits

Data analysis

Provider relations

Site visits

Education

High School Diploma

Certified Provider Credentialing Specialist

Tools

PECOS processing

NPPES updates

License tracking tools

Job description

Elevance Health is seeking a Credentialing Analyst to support infusion clinics and nursing credentialing with hybrid in-office requirements. The role involves audits, file reviews, performance analysis, and engaging with physicians and credentialing staff to resolve issues.

The position emphasizes regulatory compliance, network participation, and accreditation readiness, with a strong workflow in credentialing operations and data management.