Credentialing Coordinator - BioPlus Specialty Pharmacy

Anticipated End Date:

Position Title:

Credentialing Coordinator - Bio Plus Specialty Pharmacy

Job Description:

Credentialing Coordinator Primary Location(s):
Lake Mary, FL Hybrid:
This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Performs oversight of credentialing and re-credentialing activities and processes, including internal and external audits. Responsible for account management of contracted organizations. Acts as a liaison to delegates and credentialing vendors to ensure that credentialing program compliance requirements are maintained. Monitor contract compliance and coordinates/negotiates contractual language changes when required.

Coordinates all compliance filings of credentialing specific documents and policies.

Coordinates and conducts initial, annual and focused (corrective action plan) audits, including vendor and/or delegation oversight, or department audits. Provides feedback and recommendations to improve processes and performance.

Resolves issues independently specific to delegation oversight, sanction monitoring, validation, notification, system configuration and reporting, and credentialing policy and procedural reviews and exceptions.

Serves as corporate contact and interface with internal business partners on problems, resolutions, questions, and regulatory or accreditation audits.

Provides process oversight of daily business operations as it relates to resolution of non-responsive providers to credentialing and re-credentialing.

Maintains delegation/credentialing standards and business requirements.

Researches and resolves delegated credentialing-related issues.

Provides recommendations to committee on process administration.

Reviews assigned Health Plan elements in Credentialing Manual and provides updates as appropriate regarding new or improved documentation resources and business rules.

Leads special projects.

Requires a BA/BS degree in a related field and minimum 5 years credentialing experience; or any combination of education and experience, which would provide an equivalent background.

Strongly preferred credentialing certification.

#ELH #LI

Non-Management Non-Exempt

Job Family: PND >
Credentialing & Licensing

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.

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…