Anthem, Inc. Credentialing Specialist in Midland, Georgia
SHIFT: Day Job
Builds provider credentials file and makes file determinations regarding required credentialing criteria based on general guidelines, ensuring compliance with internal policies and external regulatory agencies.
Primary duties may include, but are not limited to:
Receives provider applications and contacts providers for any additional supporting documentation or clarification.
Builds file documentation and prepares file for credentialing committee review.
Applies general guidelines in determining whether provider meets criteria and documents deficiencies.
Prepares correspondence to providers regarding status.
Assists in researching pended and probated applications and resolving discrepancies.
Refers non-approved providers or questionable situations to senior representative.
May assist in provider education and preparation of provider training materials.
Perform verbal, written and on-line primary source verification for individual and facility organizations including but not limited to, state licensure, prescribing certificates/registrations, education, training and certification verification, accreditation status and exclusion data-base checks.
Monitor work queue to ensure applications are processed within expected turnaround times.
Requires high school diploma; 1-3 years credentialing or related experience; or any combination of education and experience, which would provide an equivalent background. 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. Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.