Remote Credentialing Analyst | National Provider Access

Elevance Health; Nashville (TN); Hybrid; USD 60,000 - 85,000; Full time

Job summary

Elevance Health is recruiting a Credentialing Analyst to support licensing and credentialing for a national virtual provider group. You will audit credentialing files, ensure documentation quality, and collaborate with internal teams and vendors to resolve issues.

The role emphasizes data analysis, process adherence, and timely communication with leadership while navigating hybrid/work-from-home policies and occasional in-person trainings.

Qualifications

• Requires a HS diploma or equivalent and minimum 3 years’ experience in a managed care environment.
• Hybrid/virtual work with occasional required in-person training.
• Strong organizational and time management skills.
• Experience in provider credentialing processes and credentialing operations.

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

NPPES knowledge

PECOS knowledge

CAQH familiarity

Medicaid enrollment experience

Provider collaboration management

Organizational skills

Education

High School diploma or equivalent

Job description

Elevance Health is recruiting a Credentialing Analyst to support licensing and credentialing for a national virtual provider group. You will audit credentialing files, ensure documentation quality, and collaborate with internal teams and vendors to resolve issues.

The role emphasizes data analysis, process adherence, and timely communication with leadership while navigating hybrid/work-from-home policies and occasional in-person trainings.