Staff VP Credentialing

/ Your Talent. Our Vision. / At Anthem, Inc., it?s a powerful combination, and the foundation upon which we?re creating greater 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.
Staff VP Enterprise Credentialing will be responsible for ensuring that members from all Lines of Business receive care from providers of an appropriate level of professional conduct and competency who also meet all NCQA, state, and federal regulatory requirements for participation. This includes credentialing over 117,900 providers and 13,584 facilities in 2015 alone.
The role will be responsible for managing the provider experience related to credentialing including metrics for turnaround time, accuracy, and efficiency.
The role is also charged with the integration of two distinct Anthem departments into one enterprise team and achieving all efficiency and effectiveness synergy targets. Process improvement will be critical to this role including workflow, use of technology, use of multi-payer platforms (i.e. CAQH) and assessing reliance on vendors. The individual will need to closely partner with executives within IT, the Provider Experience Office, Provider Data Management, Quality Management, and our 36 market/region P&L leaders.
Analyzes current operations and creates a strategy to optimize processes, break down silos, share resources/best practices, and optimize efficiency and effectiveness.
Utilizes data, analytics, performance measures and customer feedback to drive continuous process improvement.
Accountable for understanding and evaluating processes, technology, vendors, and industry best practices to deliver exceptional service. i.e.: Implement CAQH (Coalition of Affordable Quality Healthcare) tool consistent with ELT commitment to savings
Track, implement, and manage all current state, CMS, NCQA and other accreditation requirements
Drive integration of Government Business Division/Commercial Services Business Development teams, including leadership assessment
Education, Training and Experience:
BA/BS in related field
10 years? experience in a large matrixed organization;
Experience in designing and leading service innovations;
Prior accountability to many customers;
Experience managing significant vendor partnerships;
Ability to represent the organization at executive levels and externally
Heavy emphasis on operations and change management,
Experience with Provider Data Management
Preferred but not required:
Masters preferred
Six Sigma or other formal process improvement training
Experience with Provider Data Management
5 Years leadership of a credentialing organization; Experience leading large team integrations
/ Anthem, Inc. is ranked as one of America?s Most Admired Companies among health insurers by Fortune magazine and is a 2014 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at EOE. M/F/Disability/Veteran. /
Job Provider Network Management
Title: Staff VP Credentialing 123239
Location: MA-Andover
Other Locations: GA-Atlanta, Maryland, NJ-Iselin, VA-Richmond, VA-Virginia Beach, IN-Indianapolis, OH-Mason
Requisition ID: 123239 844696303eec4dd198ad2876dc09f7dc
Company Description:

We recently changed our name from WellPoint to Anthem, Inc., the name people know us by best.  As our companies continue to take a more active role in helping people access the right health care and programs, going by a name that people know and trust is important.

Anthem, Inc. is one of the nation's leading health benefits insurer and a Fortune Top 50 company.  At Anthem, Inc., we are working to transform health care with trusted and caring solutions and meaningfully advance affordability and better health outcomes for our health plan members. Nearly 69 million people are served by our affiliated companies including more than 37 million enrolled in our family of health plans. 

  • One in nine Americans receives coverage for their medical care through Anthem's affiliated plans.

  • We offer a broad range of medical and specialty products.

Bring your expertise to our innovative, achievement-driven culture, and you will discover lasting rewards and the opportunity to help drive the future of health care.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2014 DiversityInc magazine Top 50 Company for Diversity.  To learn more about our co

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