Credentialing Analyst, Infusion Clinics/Nursing

About the role

This role is a hybrid position requiring associates to be in-office 1-2 days per week, fostering collaboration and connectivity, while providing flexibility for productivity and work-life balance. Alternating locations may be considered for candidates residing within commuting distance.

Responsibilities

• Acts as a troubleshooter in resolving payor departmental issues related to credentialing.
• Manages and maintains pharmacy license tracking tool to advise pharmacy sites and pharmacists of license renewals.
• Maintains confidentiality of all pertinent pharmacy and provider information.
• Administers credentialing and re-credentialing to ensure compliance with regulatory, accreditation, and various managed care plan policies and protocols, standards, and requirements.
• Fosters collaborative relationships with managed care plans, state agencies, and PBM’s to facilitate timely credentialing and re-credentialing of applications.
• Tracks credentialing and re-credentialing to ensure compliance with time-sensitive materials.
• Maintains all pharmacy site credentialing and re-credentialing files, electronic and paper.
• Communicates with admission, billing, and clinical teams in a professional manner.
• Reviews all credentialing policies and procedures for accuracy and completeness.
• Suggests revisions of policies and procedures when necessary.
• Completes new Medicaid applications and renewals or revalidations.
• Maintains Medicaid portal and administers user access for billing.
• Pulls and maintains credentialing documents for payor applications.
• Submits new pharmacy license applications and renewals for all pharmacy sites.
• Submits Pharmacist in Charge state license changes and renewals.
• Supports URAC, ACHC, NABP during accreditation renewals.
• Submits fraud, waste, and abuse annual attestations to health plans.
• Pull and maintain credentialing documents for payor applications.
• Manage pharmacy Continuing Education Units for RFP’s.

Requirements

• Requires a H.S. diploma or equivalent and minimum of 3 years experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities And Experiences

• Knowledge of Medicaid, Medicare, managed care, and PBM providers.
• Certified Provider Credentialing Specialist and college course work.

Benefits

Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and a 401(k) match. Additional benefits include medical, dental, vision, short and long-term disability, life insurance, wellness programs, and financial education resources. The salary range for this position is $23.70 to $39.10 per hour, subject to eligibility and geographic location.

Company Information

Elevance Health is a health company dedicated to improving lives and communities. 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. We operate in a Hybrid Workforce Strategy, requiring associates to work at an Elevance Health location at least once per week, and potentially several times per week. Applicants must be vaccinated against COVID-19 and Influenza. Elevance Health is an Equal Employment Opportunity employer and follows all relevant federal, state, and local laws.