Hybrid Credentialing & Compliance Specialist

Elevance Health; Durham (NC); Hybrid; USD 65,000 - 90,000; Full time

Job summary

Elevance Health is seeking a Credentialing Coordinator to lead program-wide credentialing activities for sanctions monitoring, delegation oversight, and audits. The role coordinates audits, contract management, and vendor relationships to ensure compliance and efficient operations.

The position emphasizes collaboration with internal partners, process improvement, and maintaining standards across credentialing programs. A BA/BS with 5+ years of credentialing experience is required.

Qualifications

• Requires a BA/BS degree in a related field and minimum 5 years credentialing experience.
• Strongly preferred credentialing certification.

Responsibilities

• Oversee credentialing and re-credentialing activities and audits (internal and external).
• Manage accounts of contracted organizations and act as liaison to delegates and credentialing vendors.
• Monitor contract compliance and coordinate/negotiate contractual language changes as needed.
• Coordinate and conduct credentialing filings, audits, and corrective action plans.
• Provide feedback to improve processes and performance; resolve issues related to delegation oversight and credentialing policies.
• Serve as corporate contact with internal partners on problems, resolutions, and regulatory/audit needs.
• Maintain credentialing standards and business requirements; research and resolve credentialing issues.
• Lead special credentialing projects and review credentialing documentation and rules.

Skills

Credentialing

Compliance

Audits

Vendor management

Contract negotiation

Education

BA/BS degree

Job description

Elevance Health is seeking a Credentialing Coordinator to lead program-wide credentialing activities for sanctions monitoring, delegation oversight, and audits. The role coordinates audits, contract management, and vendor relationships to ensure compliance and efficient operations.

The position emphasizes collaboration with internal partners, process improvement, and maintaining standards across credentialing programs. A BA/BS with 5+ years of credentialing experience is required.