Hybrid Credentialing Specialist – Provider Files

Elevance Health, Inc.; Latham (NY); Hybrid; USD 28,000 - 43,000; Full time

Job summary

Elevance Health, Inc. in New York seeks a Credentialing Specialist to build provider credentialing files and determine eligibility based on general guidelines, ensuring compliance with internal policies and external regulatory agencies.

Responsibilities include receiving provider applications, gathering documentation, preparing for credentialing committee review, and addressing discrepancies while coordinating with senior staff as needed. Hybrid/office optional per policy.

Qualifications

• Must have high school diploma or equivalent and at least 1 year credentialing experience.
• Experience with provider credentialing processes preferred.
• Ability to interpret guidelines and apply regulatory requirements.

Responsibilities

• Receives provider applications and contacts providers for additional documentation or clarification.
• Builds file documentation and prepares file for credentialing committee review.
• Applies guidelines to determine whether provider meets criteria and documents deficiencies.
• Prepares correspondence to providers regarding status.
• Assists in researching pended and probated applications and resolving discrepancies.
• Refers non-approved providers or questionable situations to senior representative.
• May assist in provider education and preparation of training materials.

Skills

Credentialing basics

Documentation

Education

High school diploma or equivalent

1 year credentialing experience

Job description

Elevance Health, Inc. in New York seeks a Credentialing Specialist to build provider credentialing files and determine eligibility based on general guidelines, ensuring compliance with internal policies and external regulatory agencies.

Responsibilities include receiving provider applications, gathering documentation, preparing for credentialing committee review, and addressing discrepancies while coordinating with senior staff as needed. Hybrid/office optional per policy.