Credentialing Analyst

Credentialing Lead Analyst

Job Description

Seeking a highly organized and detail-oriented Credentialing Coordinator to manage the processes of credentialing and privileging for our Evernorth Workplace Care Medical Staff.  The successful candidate will have exceptional organizational and analytical skills, experience with state and federal regulations, and be able to work independently in a fast-paced healthcare environment. They will also have excellent communication skills and be able to prioritize multiple tasks.

Responsibilities:

• Maintain an up-to-date provider database to ensure that all healthcare providers are licensed, insured, and properly credentialed according to regulatory guidelines.
• Coordinate the credentialing and privileging process with the centralized credentialing department ensuring all relevant information is received and processed.
• Monitor the credentialing and privileging process to ensure compliance with company policies and procedures. 
• Serve as a liaison between Medical Staff Office and Providers.
• Maintain accurate physician and provider credentialing and privileging files and ensure that all required approvals are received before granting clinical privileges.
• Request Peer References and send forms to selected individuals for completion.
• Send approval letters with delineation of privileges form to providers upon completion of credentialing/recredentialing process.
• Coordinate with medical staff personnel agencies to ensure that Contract Providers and Locum Tenens are properly licensed and credentialed.  Maintain “mini credentialing” files for these providers.
• Monitor and track provider certifications and licensure expiration dates and ensure that all healthcare providers maintain current credentials.  This includes Health Coaches, Dieticians, Registered Nurses, Licensed Practical Nurses, LCSW’s, Behavior Health Providers, Physical Therapists, Athletic Trainers, etc. 
• Monitor Physician Collaborator’s for compliance with chart reviews and other requirements associated with oversight of mid-level providers.
• Communicate with healthcare providers and external agencies regarding licensing and credentialing requirements and ensure ongoing compliance with regulatory guidelines.
• Perform other duties as deemed appropriate.

Requirements:

• Minimum of 2-3 years’ experience in credentialing at a healthcare facility.
• Experience with state, federal, and accreditation entity regulations and requirements related to credentialing and privileging.
• Knowledge of credentialing software and databases.
• Strong organizational and analytical skills, with attention to detail.
• Excellent verbal and written communication skills.
• Ability to prioritize tasks and work independently.
• Comfortable working in a fast-paced healthcare environment.

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 annual salary of 54,100 - 90,100 USD / yearly, 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 and paid holidays. For more details on our employee benefits programs, click here.

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.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.