Credentialing Specialist

Anticipated End Date:

Position Title:

Credentialing Specialist

Job Description:

The Credentialing Specialist b uilds provider credentials file and makes file determinations regarding required credentialing criteria based on general guidelines ensuring compliance with internal policies and external regulatory agencies.

Location: Hy brid: This role requires associates to be in-office 1 - 2 days per week fostering collaboration and connectivity while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work promoting a dynamic and adaptable workplace. Alternate locations may be considered.

P lease 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.

How you will make an impact:

Receives provider applications and contacts providers for any additional supporting documentation or clarification.

Builds file documentation and prepares file for credentialing committee review.

Applies general guidelines in determining whether provider meets criteria and documents deficiencies.

Prepares correspondence to providers regarding status.

Assists in researching pended and probated applications and resolving discrepancies.

Refers non-approved providers or questionable situations to senior representative.

May assist in provider education and preparation of provider training materials.

Minimum Requirements:

Requires high school diploma or equivalent; minimum of 1 years credentialing or related experience; or any combination of education and experience which would provide an equivalent background.

Job Level:

Non-Management Non-Exempt

Workshift:

1st Shift (United States of America)

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.

Who We Are

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.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager associates are required to work at an Elevance Health location at least once per week and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age citizenship status color creed disability ethnicity genetic information gender (including gender identity and gender expression) marital status national origin race religion sex sexual orientation veteran status or any other status or condition protected by applicable federal state or local laws. Applicants who require accommodation to participate in the job application process may contact for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal state and local laws including but not limited to the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Required Experience:

IC