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Credentialing Specialist

Location: AL
JobFamily: Provider Network Management
Req #: PS60303
Date Posted: Oct 29, 2021

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SHIFT: Day Job

SCHEDULE: Full-time

Credentialing Specialist
Locations: TN, AL, KY, GA, MS, AR, IN (REMOTE)

The Credentialing Specialist 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. 


Minimum Requirements:

Requires high school diploma; minimum of 1 year’s 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. 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 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.

Please be advised that Anthem only accepts resumes from agencies that have a signed agreement with Anthem. Accordingly, Anthem is not obligated to pay referral fees to any agency that is not a party to an agreement with Anthem. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Anthem.