Credentialing Analyst (CareBridge)

Elevance Health•Durham, NC

1d•Remote

About The Position

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. This role supports overall licensing and credentialing efforts for a national virtual provider group. The analyst performs credentials file audits to ensure timeliness of processing, quality of documentation, and adherence to company and department policies. They also perform quality review of files to determine accuracy and completeness of all necessary documentation from associated vendors, and analyze performance data to predetermined standards. The role involves interacting with internal clinical frontline and leadership to obtain information, provide status updates, and research issues necessary for Credentials Committee review. Additionally, the analyst utilizes internal systems and runs reports/queries to research provider questions and resolve issues, and monitors license actions, complaints, and sanctions, obtaining necessary information for Managers review.

Requirements

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.

Nice To Haves

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.

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.