Remote Credentialing Specialist (Contract)

Elevance Health; Indianapolis (IN); Hybrid; USD 21,000 - 40,000; Full time

Benefits offered by this job

Benefits package

Job summary

Elevance Health seeks a Credentialing Specialist for contract work, with a 9a-5p CT schedule and up to 20 hours per week, primarily virtual with a hybrid work model. Contractors must be within a reasonable commute to a PulsePoint location and may need onsite presence at Elevance Health locations.

The role requires at least 3 years in a managed care environment and a preference for a Certified Provider Credentialing Specialist; HS diploma or equivalent is required.

Qualifications

• Requires a H.S. diploma or equivalent and minimum of 3 years experience in a managed care environment; or any combination of education and experience, which would provide an equivalent background.
• Strongly preferred certified Provider Credentialing Specialist and college course work.

Responsibilities

• Audit credentials files for timeliness and completeness.
• Review files for Medical Director and Credentials Committee.
• Analyze performance data to predetermined standards.
• Engage with physicians and credentialing staff to obtain information and provide status updates.
• Use internal systems to run reports and resolve provider questions.
• Monitor license actions, complaints, and sanctions and gather information for Manager review.
• Assist in accreditation survey preparation via data entry and reporting.
• Support and track provider appeals process.
• Potentially participate in delegation oversight activities.

Skills

Credentials audits

Quality documentation

Interdepartmental communication

Data analysis

Education

HS diploma or equivalent

Certified Provider Credentialing Specialist (preferred)

Job description

Elevance Health seeks a Credentialing Specialist for contract work, with a 9a-5p CT schedule and up to 20 hours per week, primarily virtual with a hybrid work model. Contractors must be within a reasonable commute to a PulsePoint location and may need onsite presence at Elevance Health locations.

The role requires at least 3 years in a managed care environment and a preference for a Certified Provider Credentialing Specialist; HS diploma or equivalent is required.