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Credentialing Specialist Lead

Location: , GA
Job Family: Provider Network Management
Req #: PS45934
Date Posted: May 13, 2021


SHIFT: Day Job

SCHEDULE: Full-time

Your 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.

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.

Credentialing Specialist Lead

Serves as team lead in the credentialing unit and/or for managing major projects and representing credentialing decisions to reviewing committee.

Primary duties may include, but are not limited to:

  • Establishes work priorities for the assigned team.
  • Responsible for compiling weekly, monthly and quarterly data and analyzing data to identify trends, areas of deficiency or concern
  • Responsible for developing presentation materials and reports for leadership and customer on a routine basis
  • Provide introductory and ongoing training and education to staff to ensure that policies and procedures are followed
  • Meet with the Manager regularly to effectively communicate and resolve issues, set and prioritize goals, and improve processes
  • Assist with staff communication, providing updates, resolving issues, setting goals, and maintaining standards
  • Serve as the initial path of escalation for customer related issues  
  • Monitor and track staff performance through established reporting mechanisms, create new reporting mechanisms as needed
  • Carry-out quality assurance monitoring activities for the entire team and ensure all provider credentialing submissions are processed timely and accurately
  • Maintain established departmental policies and procedures, objectives, and customer service policies
  • Assist Manager with development and implementation of project plans
  • Perform other duties as assigned
  • Establish weekly quality checks for team work products
  • Serves as subject matter expert who may be assigned major projects within the department, primarily to include delegation oversight and compliance.
  • Capturing primary source documentation in computer databases.
  • Coordinates all research required on issues pended from the committee

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 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.


  • Requires a BA/BS degree in a related field;
  • 5-7 years credentialing experience; or any combination of education and experience, which would provide an equivalent background.
  • Certification preferred.
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