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Credentialing Quality Auditor

Location:

  • National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint

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Description

Build the Possibilities. Make an extraordinary impact.

As a Credentialing Quality Auditor (formal Elevance job title: Credentialing Analyst) you are responsible for:

  • Ensuring that all credentialing files are in compliance with hospital accreditation standards, medical staff bylaws, regulatory bodies, federal and state laws, and internal policies.
  • In accordance with a prescribed timeline for credentials committee each month, you will review initial application and reappointment application files to ensure the accuracy and completeness of verifications performed by the Credentialing Specialists.
  • All file reviews will confirm compliance with all required elements for a file as follows: education and training, licensure, work history, liability history, privileging history, board certification, peer references, clinical case activity, time gaps, red flags, and all associated images or supplemental documentation.
  • This role is also relied upon as a resource for ongoing education and collaboration for individuals within the department.


How you will make an impact:

  • Performs more complex activities in support of provider credentialing, including additional NCQA research, auditing credentialing files, communicating errors to Credentialing Specialists.
  • 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 for Medical Director and Credentials Committee.
  • Analyze performance data and provide appropriate recommendation to improve Credentialing processes and workflows.
  • Utilizes internal Credentialing systems and runs reports/queries to research provider questions and resolve issues.

Minimum Requirements:

  • H.S. diploma and
  • Minimum of 3 years experience in a managed care environment;
  • Or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

  • Strongly preferred Certified Provider Credentialing Specialist (CPCS) and college course work.
  • Experience in Behavioral Health credentialing strongly preferred.
  • Dmonstrated knowledge of medical terminology preferred.
  • Proficiency with credentialing database technology as well as Microsoft Office applications (Outlook, Excel, Word) strongly preferred.
  • Proficiency in use of related applications/internal systems to collect information necessary to complete principal accountabilities preferred.
  • Effective verbal and written communication skills preferred.
  • Ability to plan own schedule, set priorities and work independently in accomplishing work assignments on time preferred.

Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Be part of an Extraordinary Team

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

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.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealthinc.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

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