Senior Credentialing Specialist — Hybrid, Audits & Compliance

Elevance Health, Inc.; Atlanta (GA); Hybrid; USD 33,000 - 50,000; Full time

Job summary

Elevance Health, Inc. is seeking a Credentialing Specialist Senior to ensure the integrity of credentialing data and provide guidance to fellow credentialing associates.

The role is hybrid, requiring in-office presence 1-2 days per week, with possible alternate locations for commuting candidates. The position supports credentialing committees, reviews documentation, and resolves complex credentialing matters.

Qualifications

• Requires a H.S. diploma or equivalent and minimum of 4 years credentialing experience; or any combination of education and experience, which would provide an equivalent background.
• Practitioner and facility credentialing experience strongly preferred.
• CPCS or CMSC certification preferred.

Responsibilities

• Audits work of other credentialing associates.
• Compiles and reviews documentation required by credentialing committee.
• Responds to the most complex provider credentialing, compliance and accreditation issues.
• Researches pended and probated applications and resolves discrepancies.
• Monitors reports identifying practitioners on sanctions or those who do not meet credentialing criteria for further action and assists in researching related issues.
• May assist in delegation oversight and identifies on-going training needs.
• Assists in developing training materials.

Education

High School diploma or equivalent

Job description

Elevance Health, Inc. is seeking a Credentialing Specialist Senior to ensure the integrity of credentialing data and provide guidance to fellow credentialing associates.

The role is hybrid, requiring in-office presence 1-2 days per week, with possible alternate locations for commuting candidates. The position supports credentialing committees, reviews documentation, and resolves complex credentialing matters.