Credentialing Specialist Senior at Elevance Health

Atlanta, Georgia, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

H.S. diploma or equivalent
Minimum of 4 years credentialing experience (or any combination of education and experience providing equivalent background)
Ability to work hybrid (in office 1-2 days per week; candidates not within reasonable commuting distance not considered unless accommodation granted)

Responsibilities

Audits work of other credentialing associates
Compiles and reviews documentation required by credentialing committee
Responds to the most complex provider credentialing, compliance, and accreditation issues
Researches pended and probated applications and resolves discrepancies
Monitors reports identifying practitioners on sanctions or those who do not meet credentialing criteria for further action and assists in researching related issues
May assist in delegation oversight and identifies ongoing training needs
Assists in developing training materials
Ensures the integrity of credentialing data and provides expertise and guidance to other credentialing associates

Skills

credentialing

CPCS

CMSC

auditing

compliance

accreditation

delegation oversight

training development

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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