Credentialing Specialist at Elevance Health

Atlanta, Georgia, United States

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Not SpecifiedCompensation

Entry Level & New GradExperience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

High school diploma or equivalent
Minimum of 1 year credentialing or related experience (or any combination of education and experience providing equivalent background)
Ability to commute to office 1-2 days per week (candidates not within reasonable commuting distance generally not considered unless accommodation granted)
Vaccination against COVID-19 and Influenza for certain patient/member-facing roles (or acceptable explanation)

Responsibilities

Receives provider applications and contacts providers for additional supporting documentation or clarification
Builds provider credentials file and prepares file for credentialing committee review
Applies general guidelines to determine if 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
Makes file determinations regarding required credentialing criteria based on general guidelines, ensuring compliance with internal policies and external regulatory agencies
May assist in provider education and preparation of provider training materials

Skills

Credentialing

Provider Enrollment

Documentation

Regulatory Compliance

File Preparation

Correspondence

Application Review

Elevance Health

Integrated health services and digital platform

About Elevance Health

Elevance Health focuses on enhancing the health of individuals throughout their lives by evolving from a traditional health benefits organization into a comprehensive health partner. The company serves over 118 million people, providing support at every stage of health through an integrated approach that addresses a wide range of health needs. Their services are backed by advanced capabilities and a digital health platform that streamlines access to care. Unlike many competitors, Elevance Health emphasizes a holistic view of health, aiming to redefine health and improve community well-being. The ultimate goal is to make health improvements accessible to everyone.

Indianapolis, IndianaHeadquarters

1944Year Founded

$309.4MTotal Funding

IPOCompany Stage

Enterprise Software, Social Impact, HealthcareIndustries

10,001+Employees

Benefits

Medical, dental, & vision insurance

401(k) + match

Paid holidays

Paid Time Off

Incentive bonus programs

Stock purchase plan

Life insurance

Wellness Programs

Financial education resources

Adoption & Surrogacy Assistance

Dependent-care Flexible Spending Account (DCFSA)

Parental Leave

Parental Transition Week

Critical Caregiving Leave

Risks

Departure of CFO John Gallina may create a gap in financial leadership.

Lawsuit against CMS over MA Star Ratings could lead to financial penalties.

CareBridge integration may face operational challenges, disrupting service delivery.

Differentiation

Elevance Health integrates whole health approach with digital health platform for comprehensive care.

Acquisition of CareBridge enhances home health services within Carelon division.

Strategic partnership with Clayton, Dubilier & Rice aims to innovate primary care delivery.

Upsides

AI integration in home health services can reduce hospital readmissions and improve outcomes.

Predictive analytics support early disease detection, aligning with Elevance's whole health approach.

Telehealth expansion offers opportunities to reach more patients remotely.

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