Job Description

The Credentialing Sr. Representative is responsible for gathering credentialing application documentation, accurately entering data into the credentialing database, obtaining primary source verifications and evaluating the applicant according to NCQA and eviCore credentialing requirements. The role involves credentialing practitioners and facilities who are contracted for eviCore healthcare networks. This position will have direct contact with the network to assist with questions related to the credentialing process. This role requires review of credentialing applications and other relevant documents in a time sensitive manner. This includes certificates of licensure, accreditation, liability insurance, clinical privileges and Medicare/Medicaid reports, all while ensuring compliance with CMS, NCQA, URAC and eviCore Network Standards.

What you must have

High school diploma or 4+ years of credentialing experience.

Knowledge of NCQA credentialing standards is preferred.

Intermediate knowledge of and experience with Microsoft Word, Outlook, Excel, and PowerPoint are required.

Ability to understand and follow oral and written directions, complete assigned tasks, and manage multiple time sensitive assignments independently is also required.

Strong verbal and written communications skills are a must.

Duties and Responsibilities

Reviewing credentialing and recredentialing applications for the information necessary to determine a practitioner’s eligibility for network participation using the guidelines and standards set forth by the National Committee of Quality Assurance (NCQA)

Perform Primary Source Verifications (PSVs) to ensure all applicants are in good standing with their applicable licensing Board(s) and other monitoring agencies

Data entry and maintenance of information housed in the Cactus profiling system, the credentialing data base used by the department

Outreach to practitioners regarding the return of information needed to complete the credentialing or recredentialing process

Processing practitioners for approval, denial or termination from network participation

Other duties as required

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 19 - 29 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.

We want you to be healthy, balanced, and feel secure. That’s why 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) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group .

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 require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.

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.

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