Remote Credentialing Analyst – Licensing & Audits

The Elevance Health Companies, Inc.; Nashville (TN); Hybrid; USD 52,000 - 73,000; Full time

Job summary

Elevance Health is seeking a Credentialing Analyst for a national virtual provider group. The role involves credentialing research, audits, appeals, and coordination with providers and internal teams.

Responsibilities include file audits, quality reviews, data analysis, and ensuring timely credentialing processes. In-person trainings may be required, with hybrid/virtual work options and a focus on compliance and provider collaboration.

Qualifications

• Requires a high school diploma or equivalent and 3+ years in a managed care environment.
• Familiarity with NPPES, PECOS, CAQH, and Medallion Platforms.
• Experience in Medicaid Provider Enrollment and with frontline providers.

Responsibilities

• Supports overall licensing and credentialing efforts for a national virtual provider group.
• Performs credentials file audits to ensure timeliness of processing, quality of documentation, and adherence to company and department policies.
• Performs quality review of files to determine accuracy and completeness of all necessary documentation from associated vendors.
• Analyzes performance data to predetermined standards.
• Interacts with internal clinical frontline and leadership to obtain information, provide status updates, research issues necessary for Credentials Committee review.
• Utilizes internal systems and runs reports/queries to research provider questions and resolve issues.
• Monitors license actions, complaints, and sanctions and obtains necessary information for Managers review.

Skills

Managed care

NPPES/PECOS/CAQH

Organizational skills

Provider enrollment

Frontline providers

Education

H.S. diploma or equivalent

Job description

Elevance Health is seeking a Credentialing Analyst for a national virtual provider group. The role involves credentialing research, audits, appeals, and coordination with providers and internal teams.

Responsibilities include file audits, quality reviews, data analysis, and ensuring timely credentialing processes. In-person trainings may be required, with hybrid/virtual work options and a focus on compliance and provider collaboration.