Remote Credentialing Analyst (Licensing & Audits)

Elevance Health (Anthem)

Nashville (TN)

Hybrid

USD 55,000 - 75,000

Full time

5 days ago

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Job summary

Elevance Health is seeking a Credentialing Analyst (CareBridge) to join our national virtual provider operations. The role involves complex credentialing activities, audits, and oversight for the Credentials Committee with collaboration across internal teams.

You will support licensing, file reviews, data analysis, and issue resolution while ensuring adherence to policies and timelines. This position offers hybrid/work-flexible arrangements near a designated office.

Qualifications

Requires a high school diploma or equivalent with at least 3 years in a managed care environment.
Experience with frontline providers is preferred.
Familiarity with NPPES, PECOS, CAQH, and Medallion platforms is a plus.

Responsibilities

Supports licensing and credentialing for a national virtual provider group.
Performs credentials file audits to ensure timeliness and quality documentation.
Reviews files for accuracy and completeness with vendors.
Analyzes performance data to predefined standards.
Interacts with clinical teams to obtain information for Credentials Committee review.
Utilizes internal systems and runs reports to resolve credentialing queries.
Monitors license actions, complaints, and sanctions for Managers review.