Anthem, Inc. Credentialing Specialist Sr. in Baltimore, Maryland
SHIFT: Day Job
Ensures the integrity of credentialing data and provides expertise and guidance to other credentialing associates.
Primary duties may include, but are not limited to:
Audits work of other credentialing associates.
Conduct oversight of daily approval credentialing process.
Compiles and reviews documentation required by credentialing committee.
Responds to the most complex provider credentialing, compliance and accreditation issues.
Assist in daily inventory management and escalations.
Researches pended and probated applications and resolves discrepancies.
Monitors reports identifying practitioners on sanctions or those who do not meet credentialing criteria for further action and assists in researching related issues.
May assist in delegation oversight and identifies on-going training needs. Assists in developing training materials.
Requires a H.S. diploma; 4-5 years credentialing experience; or any combination of education and experience, which would provide an equivalent background.
CPCS or CMSC preferred.
Knowledge of Cactus preferred.