Credentialing Senior Representative - MD Live - Remote

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.

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