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Managed Care Credentialing Specialist
2 months ago
Be Part of an Extraordinary Team
A proud member of the Elevance Health family of companies, Paragon Healthcare brings over 20 years in providing life-saving and life-giving infusible and injectable drug therapies through our specialty pharmacies, our infusion centers, and the home setting.
Title: Managed Care Credentialing Specialist (Risk Management Analyst)
Location: This position will work a hybrid (remote and office) schedule with 1-2 days in office per week. Candidates must live within 50 miles or a 1 hour commute of the 3033 W. President George Bush HWY, Ste 100, Plano, TX 75075 Elevance Health office.
Shift: Monday through Friday, Business Standard Hours (CST).
Build the Possibilities. Make an Extraordinary Impact.
The Managed Care Credentialing Specialist is responsible for Responsible for supporting the department regarding all aspects of the corporate insurance program.
How you will make an impact:
Primary duties include, but are not limited to:
- Gathers, records, and maintains credentialing information for new payor contract applications and renewals.
- Primary duties may include, but are not limited to: Performs department credentialing and contracting functions including, ongoing maintenance and reporting network access gaps.
- Maintains the departmental payor activity library. Maintains, tracks, and renews payor credentialing for all lines of business.
- Produces credentialing reports as needed.
- Acts as a liaison between contracting and internal departments coordinating claims denial interventions, tracking resolution, and implementing ongoing solutions.
- Acts as a contact to the payor for missing or additional credentialing documentation requirements.
- Requires a BA/BS; or any combination of education and experience, which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences:
- Experience managing multiple applications at once and working efficiently to meet or exceed deadlines.
- Ability to correctly interpret and utilize provider taxonomy, NPI, and other identifiers in payor credentialing applications.
- 3+ years experience in completing payor credentialing applications through various methods highly preferred.
- Experience navigating Icertis Contract Management or any other contract management software preferred.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. 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.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
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.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
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 elevancehealthjobssupport@elevancehealth.comfor assistance.
