Credentialing Analyst – Infusion Clinics

Elevance Health

Credentialing Analyst managing the credentialing process for pharmacy sites. Ensuring compliance with regulator policies and maintaining partnerships with health plans and PBMs.

Posted 7/22/2026full-timeLake Mary • Florida, Illinois, Ohio • 🇺🇸 United StatesMid-LevelSenior💰 $24 - $39 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in credentialing and re-credentialing processes, ensuring compliance with regulatory standards and fostering relationships with managed care plans and pharmacy benefit managers. Proficient in managing pharmacy license tracking and maintaining accurate credentialing files.

Highest-signal resume keywords

Credentialing ManagementMedicaid KnowledgeMedicare ProcessingProvider Credentialing Specialist CertificationPharmacy Benefit Manager (PBM) Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

CredentialingRe-CredentialingPolicy ReviewLicense TrackingNPI Profile UpdatesMedicaid ApplicationsMedicare (PECOS) ProcessingNCPDP Profile MaintenanceFraud, Waste and Abuse AttestationContinuing Education Units Management

Soft Skills

Effective CommunicationTroubleshootingCollaborationConfidentiality MaintenanceProfessionalism

Tools & Technologies

Pharmacy License Tracking ToolCredentialing Files Management System

Certifications & Qualifications

Certified Provider Credentialing Specialist

Industry Keywords

Managed CarePharmacy Benefit Managers (PBM)URACACHCNABP

About the role

Key responsibilities & impact

Responsible for accurate and prompt credentialing for health plans and pharmacy benefit managers (PBM).
Acts as a troubleshooter in resolving payor departmental issues related to credentialing.
Manages and maintains pharmacy license tracking tool to advise pharmacy sites and pharmacists of license renewals.
Maintains confidentiality of all pertinent pharmacy and provider information.
Administers credentialing and re-credentialing to ensure compliance with regulatory, accreditation and various managed care plan policies and protocols, standards, and requirements.
Develops and fosters collaborative relationships with managed care plans, state agencies and PBM’s to facilitate timely credentialing and re-credentialing of applications.
Tracks credentialing and re-credentialing to ensure compliance with time sensitive materials.
Maintains all pharmacy site credentialing and re-credentialing files, electronic and paper.
Effectively communicates with admission, billing, and clinical teams in a professional manner.
Reviews all credentialing policies and procedures for accuracy and completeness.
Suggests revisions of policies and procedures when necessary.
Completes new Medicaid applications and renewals or revalidations.
Manages PBM credentialing requests and maintenance.
Medicare (PECOS) processing for all pharmacy sites.
Maintains NCPDP profile for all pharmacy sites.
Certificate of Insurance requests and dissemination to plans or CMS.
NPI profile updates (NPPES).
URAC, ACHC, NABP support during accreditation renewals.
Fraud, Waste and Abuse annual attestation submission to health plans.
Manage pharmacy Continuing Education Units for RFP’s.

Requirements

What you’ll need

Requires a H.S. diploma or equivalent and minimum of 3 years experience; or any combination of education and experience, which would provide an equivalent background.
Knowledge of Medicaid, Medicare, managed care, and PBM providers.
Certified Provider Credentialing Specialist and college course work.

Benefits

Comp & perks

comprehensive benefits package
incentive and recognition programs
equity stock purchase
401k contribution