- Provides advanced professional input to complex Provider Credentialing assignments/projects.
- Implements and monitors the procedures for the credentialing or re-credentialing of physicians and/or providers.
- Tracks delegation oversight activity and re-credentialing activity and corrective actions.
- Documents peer review activities and materials.
- Performs on site state and internal audits.
- Coordinates credentialing reporting systems to monitor credentialing/re-credentialing activity, delegation oversight, vendor management, sanction monitoring and facility credentialing/re-credentialing activities.
- Partners with contracting in negotiating contracts with delegated vendors.
- Manages data preparation and assists with development of recommendations for credentialing committee review and approval.
- May lead department projects. Supports and provides direction to more junior professionals.
- Works autonomously, only requiring "expert" level technical support from others.
- Exercises judgment in the evaluation, selection, and adaptation of both standard and complex techniques and procedures.
- Utilizes in-depth professional knowledge and acumen to develop models and procedures, and monitor trends, within Credentialing.
- Bachelor's Degree or equivalent work experience. HS Diploma required
- At least 2-4 years related of credentialing experience
- Proficiency in MS Office including MS Excel.
- Experience with Access strongly preferred.
- Strong attention to detail.
- Ability to work in a fast-paced environment/multi-task.
- Excellent communication, organizational and time management skills essential.
- Ability to work well with all levels of internal and external contacts required.
- Ability to work with minimum management oversight.
- Professional demeanor at all times.
- Strong complex problem solving skills.
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Credentialing Lead Analyst-Express Scripts - Remote, United States - The Cigna Group
Description
The job profile for this position is Credentialing Lead Analyst, which is a Band 3 Senior Contributor Career Track Role.Excited to grow your career?
We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply
Our people make all the difference in our success.
This role will assist the credentialing team by providing more oversight of our audit support and compliance with contractual, regulatory, and accreditation requirements. This individual would be focused on ensuring we have the right SOPs, that people are following the SOPs, ensuring QA processes are robust and standardized and that the processing work the team does day in and day out will allow us to remain compliant with any and all audit requests.
ESSENTIAL FUNCTIONS:
QUALIFICATIONS:
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.
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.Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link.
