Credentialing Analyst (CareBridge)

Credentialing Analyst LOCATION : This is a virtual eligible role. You should be within a reasonable proximity to one of our offices. HOURS : General business hours, Monday through Friday. Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions (when indicated), providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law. The Credentialing Analyst performs more complex activities in support of provider credentialing to include additional research, auditing, managing credentialing appeals, special projects, delegation oversight, and site visits. How will you make an impact: 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.

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.

Familiarity with NPPES, PECOS, CAQH, and Medallion Platforms Strong organizational and time management skills Experience in NLC, Medicaid Provider Enrollment, and Provider Collaboration Agreement Management experience. Experience working with frontline providers. Job Level: Non-Management Non-Exempt Workshift: Job Family: PND > Credentialing & Licensing Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.