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Position Description:
The Provider Credentialing Senior Representative is responsible for executing core credentialing and provider data management functions to ensure compliance with regulatory and organizational standards. This role supports the full credentialing lifecycle, including initial credentialing, re-credentialing, and privileging of providers, while maintaining accurate records and delivering high-quality service to internal and external stakeholders.
Essential Job Functions:
Perform delegated credentialing activities, including initial credentialing, re-credentialing, and privileging in accordance with established policies and procedures
Process provider applications and re-applications, including distribution, review for completeness, and system data entry
Verify provider credentials, including licenses, certifications, and other regulatory requirements
Maintain accurate provider profiles within credentialing and provider management systems
Prepare credentialing files and documentation for committee review, ensuring completeness and compliance
Manage incoming communications in the Credentialing and Verifications and Government Programs inbox, ensuring timely and accurate responses
Respond to provider inquiries related to credentialing status, liability coverage, licensure updates, and demographic/profile changes
Process employment and credentialing verification requests in a timely manner
Triage and route incoming requests and inquiries to appropriate internal departments for resolution
Support Medicaid provider enrollment activities, including maintaining accurate enrollment records and ensuring proper state linkages
Conduct routine audits and assist with departmental projects and process improvement initiatives
Identify and proactively address potential issues, demonstrating forward planning and problem-solving capabilities
Resolve non-routine or escalated issues and provide guidance to junior team members as needed
Education and Experience:
2+ years of experience in provider credentialing, provider enrollment, or healthcare operations (preferred)
Knowledge of credentialing standards, regulatory requirements, and verification processes
Experience with Medicaid enrollment processes and multi-state provider management (preferred)
Strong attention to detail with the ability to manage multiple priorities in a fast-paced environment
Excellent written and verbal communication skills
Ability to work independently while collaborating cross-functionally
Proficiency with credentialing systems, databases, and Microsoft Office tools
Organizational and time management skills
Problem-solving and critical thinking
Attention to detail and accuracy
Customer Service Orientation
Process improvement mindset
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
For this position, we anticipate offering an hourly rate of 21 - 32 USD / hourly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
At The Cigna Group, you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and leaves of absence. For more details on our employee benefits programs, click here (https://jobs.thecignagroup.com/us/en/benefits) .
About Evernorth Health Services
Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.