Hybrid Credentialing Analyst, Infusion Clinics

The Elevance Health Companies, Inc.; Town of Florida (NY); Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Merit increases

Paid holidays

Paid time off

Incentive programs

Medical insurance

Dental

Vision

Disability insurance

401(k) + match

Stock purchase plan

Life insurance

Wellness programs

Financial education

Job summary

Elevance Health is seeking a Credentialing Analyst for Infusion Clinics/Nursing in a hybrid setting. The role requires collaboration with Medical Directors and Credentials Committee to ensure timely, accurate credentialing processing and documentation adherence.

Responsibilities include audits, data analysis, site visits, and coordination with physicians and staff across networks. Prior experience in managed care and credentialing is required.

Qualifications

• Requires a high school diploma or equivalent and 3 years in a managed care environment.
• Knowledge of Medicaid/Medicare and PBM providers preferred.
• Experience credentialing provider/pharmacy and re-credentialing.
• Experience maintaining credentialing files and renewals with confidentiality.

Responsibilities

• Performs credentials file audits for timeliness and documentation adherence.
• Quality review of files for accuracy 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.
• Uses internal systems and runs reports to research questions and resolve issues.
• Monitors license actions, complaints, and sanctions and obtains information for managers.
• Prepares documentation for Medical Directors for off-cycle reviews.
• Maintains provider peer review information in the credentialing database.

Skills

Credentialing

Medicaid/Medicare

PBM knowledge

NPI & PECOS

Licensing coordination

Data integrity

Education

High school diploma or equivalent

Tools

Credentialing systems

Job description

Elevance Health is seeking a Credentialing Analyst for Infusion Clinics/Nursing in a hybrid setting. The role requires collaboration with Medical Directors and Credentials Committee to ensure timely, accurate credentialing processing and documentation adherence.

Responsibilities include audits, data analysis, site visits, and coordination with physicians and staff across networks. Prior experience in managed care and credentialing is required.