Anthem Inc. Jobs

Job Information

Anthem, Inc. Credentialing Specialist Sr. in Baltimore, Maryland

Description

SHIFT: Day Job

SCHEDULE: Full-time

Responsibilities:

Ensures the integrity of credentialing data and provides expertise and guidance to other credentialing associates.

Primary duties may include, but are not limited to:

  • Audits work of other credentialing associates.

  • Conduct oversight of daily approval credentialing process.

  • Compiles and reviews documentation required by credentialing committee.

  • Responds to the most complex provider credentialing, compliance and accreditation issues.

  • Assist in daily inventory management and escalations.

  • 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 on-going training needs. Assists in developing training materials.

Qualifications

Requirements:

  • Requires a H.S. diploma; 4-5 years credentialing experience; or any combination of education and experience, which would provide an equivalent background.

  • CPCS or CMSC preferred.

  • Knowledge of Cactus preferred.

    REQNUMBER: PS51988

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