Anthem Credentialing Spec Lead PS8707 in Colorado Springs, Colorado

Credentialing Spec Lead PS8707


Location: Seattle, Washington, United States

Field: Provider Network Management

Requisition #: PS8707

Post Date: Jun 26, 2018

Amerigroup Washington

At Amerigroup, a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, it’s a powerful combination. It’s 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.

Dept: Credentialing

Status: Salaried Fulltime – 40 hours/wk

Location:The preferred location for this position is Seattle, WA, but we will consider any Anthem locationor work from home if qualified.

Job Summary:

Serves as Team Lead for the Washington market credentialing team 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; Assists in process improvement;

Serves as subject matter expert who may be assigned major projects within the department, to include oversight and compliance of credentialing activities.

Assists with the work flow, training, and reviewing of files prior to submission to the Credentials Committees.

Manages SharePoint site for credentialing applications.

Manages internal reporting to maintain appropriate turnaround times and service level agreements.

Attends committee meetings and is responsible to present cases to the credentialing committee and to be able to explain decisions where discretion was used.

Coordinates all research required on issues pended from the committee.

This position assists in compliance with the accrediting and regulatory agencies (i.e. NCQA, CMS, and WA State) in regard to credentialing while developing and maintaining a working knowledge of the statutes and laws.

• Team lead should be at higher end of experience level and certified;

• 5-7 years credentialing experience; or any combination of education and experience, which would provide an equivalent background;

• BA/BS degree in a related field preferred;

• CPCS or CPMSM certification preferred;

• Working knowledge of NCQA credentialing standards

• Working knowledge of WA HCA/Apple Health Managed Care

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at EOE. M/F/Disability/Veteran.