Gianna Archibald
Credentialing Specialist Lead @Elevance Health
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WORK HISTORY
Credentialing Specialist Lead @Elevance Health
Manchester, NH, US
EDUCATION
Cambridge College
Bachelor of Arts - BA
Northern Essex Community College
Associate of Arts - AA
ABOUT GIANNA ARCHIBALD
Credentialing Team Lead for the Anthem Blue Cross and Blue Shield health plan within the state of Georgia.*Georgia Credentials Committee oversight *Initial and Re-credentialing practitioner and facility providers *Ongoing monitoring sanction reports (federal and state)*Quality of Care/Peer Review Committee recommendations *Program Integrity reviews *Delegation audit review/approval *Process & Policy revisions/updates/annual reviews *Appeals-reconsideration, meet and confer, and formal appeals process for denied/terminated providers.*Daily inventory oversight of provider files to maintain compliance, SLAs, company TATs to include follow up with vendor team.*Internal and external audit review and preparation to ensure NCQA, state and federal regulation, corporate policy, accreditation requirements are followed.*Training support *Credentialing SME for new initiatives, testing, implementations, and optimization opportunities within organization *Support systems testing, process improvement development, workflow management, and monitor legislative changes affecting respective market assignment.
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