Hybrid Credentialing Specialist: Provider Files & Compliance

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

Job summary

Elevance Health is seeking a Credentialing Specialist to join our hybrid team in Nashville. You will build provider credentials files, apply guidelines, and prepare documentation for credentialing committees, ensuring compliance with internal policies and external regulators.

You will collect supporting documentation, resolve discrepancies, and communicate status to providers, supporting the credentialing workflow with accuracy and timeliness in a dynamic healthcare environment.

Qualifications

• Requires high school diploma or equivalent; minimum of 1 years credentialing or related experience; or any combination of education and experience, which would provide an equivalent background.
• Practitioner and facility credentialing strongly preferred.

Responsibilities

• Receives provider applications and contacts providers for any additional supporting documentation or clarification.
• Builds file documentation and prepares file for credentialing committee review.
• Applies general guidelines in determining 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 provider training materials.

Skills

Credentialing experience

Education

High school diploma or equivalent

Job description

Elevance Health is seeking a Credentialing Specialist to join our hybrid team in Nashville. You will build provider credentials files, apply guidelines, and prepare documentation for credentialing committees, ensuring compliance with internal policies and external regulators.

You will collect supporting documentation, resolve discrepancies, and communicate status to providers, supporting the credentialing workflow with accuracy and timeliness in a dynamic healthcare environment.