at Anthem, Inc in Wilmington, Delaware, United States
DescriptionSHIFT: Day Job
SCHEDULE: Full-timeYour Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.
A Credentialing Analyst p erforms more complex activities in support of provider credentialing to include additional research, auditing, managing credentialing appeals, special projects, delegation oversight, and site visits.
Primary duties may include, but are not limited to:
+ 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. Analyzes performance data to predetermined standards.
+ May also perform site visits of provider offices for participation in networks. Interacts with physicians, office managers, credentialing staff from other organizations to obtain information, provide status updates, research issues necessary for Credentials Committee review.
+ Utilizes internal systems and runs reports/queries to research provider questions and resolve issues.
+ Monitors license actions, complaints, and sanctions and obtains necessary information for Managers review.
+ Prepares documentation for Medical Directors consideration of off-cycle review.
+ Maintains provider peer review information on the credentialing database system. Supports and tracks provider appeals process. May assume responsibility for delegation oversight activities. Participates in accreditation survey preparation via data entry, reporting, and acting as task force liaison
+ H.S. diploma; at least 3 years experience in a managed care environment; or any combination of education and experience, which would provide an equivalent background.
+ Certified Provider Credentialing Specialist and college course work preferred.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. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s 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. REQNUMBER: PS58133