Credentialing Analyst

Elevance Health • Nashville, TN

9d • Remote

About The Position

Credentialing Analyst CareBridge Health is a proud member of the Elevance Health family of companies, within our Carelon business. CareBridge Health exists to enable individuals in home and community-based settings to maximize their health, independence, and quality of life through homecare and community-based services. 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. 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.

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.

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees