Hybrid Credentialing Analyst, Infusion Clinics

Elevance Health; Mason (OH); Hybrid; USD 60,000 - 85,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401(k) + match

Life Insurance

Job summary

Elevance Health seeks a Credentialing Analyst for Infusion Clinics/Nursing to manage complex provider credentialing activities, including audits, appeals, site visits, and delegation oversight. The role supports Medical Directors and the Credentials Committee through file reviews and data analyses.

The position collaborates with physicians, office managers, and payer teams in a hybrid environment, requiring 1–2 days in-office weekly and travel as needed for site visits.

Qualifications

• Requires a H.S. diploma or equivalent and minimum of 3 years experience in a managed care environment; or any combination of education and experience, which would provide an equivalent background.
• Knowledge of Medicaid, Medicare, managed care, and PBM providers.
• Experience administering provider/ pharmacy credentialing and re-credentialing to meet regulatory, accreditation (URAC/ACHC), and managed care plan requirements.
• Experience tracking, organizing, and maintaining credentialing files and time-sensitive renewals, ensuring accuracy and confidentiality.
• Experience serving as a credentialing troubleshooter, resolving payer/PBM-related issues and credentialing delays.
• Experience managing state Medicaid processes (new applications, renewals/revalidations) including portal maintenance and user access.
• Experience with Medicare PECOS processing, NPI updates, and maintaining NCPDP profiles for multiple sites.
• Experience coordinating pharmacy site and pharmacist licensing and maintaining license tracking tools.
• Experience supporting payer and compliance documentation needs and collaborating with billing, clinical, and admissions teams.
• Certified Provider Credentialing Specialist and college course work.

Responsibilities

• Performs credentials file audits to ensure timeliness of processing and adherence to policies.
• Performs quality review of files for Medical Director and Credentials Committee.
• Analyzes performance data to predetermined standards.
• May perform site visits of provider offices for network participation.
• Interacts with physicians, office managers, credentialing staff to obtain information and provide updates.
• Uses internal systems and runs reports to research provider questions and resolve issues.
• Monitors license actions, complaints, and sanctions for Managers review.
• Prepares documentation for Medical Directors consideration of off-cycle review.
• Maintains provider peer review information on credentialing database systems.
• Supports and tracks provider appeals process.
• May oversee delegation activities.
• Participates in accreditation survey preparation via data entry and reporting.

Skills

Credentialing

Payer coordination

Regulatory compliance

Healthcare auditing

PBM knowledge

Medicaid/Medicare

Education

CPCS certification

College coursework

Job description

Elevance Health seeks a Credentialing Analyst for Infusion Clinics/Nursing to manage complex provider credentialing activities, including audits, appeals, site visits, and delegation oversight. The role supports Medical Directors and the Credentials Committee through file reviews and data analyses.

The position collaborates with physicians, office managers, and payer teams in a hybrid environment, requiring 1–2 days in-office weekly and travel as needed for site visits.