Delegated Credentialing Lead Analyst - Evernorth - Remote

📋 Description

• • As a Delegated Credentialing Lead Analyst at The Cigna Group, you will be at the forefront of ensuring the integrity and compliance of our provider network through meticulous delegation oversight. This pivotal role involves managing the selection and retention of provider groups who are seeking or have been awarded delegated credentialing across our Behavioral, Dental, and Medical lines of business. Your expertise will be crucial in maintaining the high standards expected by Cigna and regulatory bodies, ensuring seamless operations and exceptional patient care.
• • Your primary responsibility will be to conduct comprehensive practitioner and provider group credentialing audits. These audits will encompass initial, annual, and interim assessments, all performed in strict accordance with Cigna's internal policies and the stringent regulatory requirements set forth by the Centers for Medicare & Medicaid Services (CMS). This involves a deep dive into provider qualifications, licensing, and adherence to best practices, safeguarding the quality of care delivered under our network.
• • A significant aspect of this role includes the negotiation and management of delegation contractual agreements. You will be instrumental in establishing and maintaining robust contractual relationships with delegated provider groups, ensuring that all terms and conditions are clearly defined, understood, and met. This requires a keen understanding of legal and business implications, fostering collaborative partnerships that benefit both the provider groups and The Cigna Group.
• • You will serve as a key contributor during internal and external organizational audits. Your ability to present clear, concise, and accurate information will be vital in demonstrating our commitment to compliance and operational excellence. This involves preparing documentation, responding to inquiries, and collaborating with audit teams to ensure a smooth and successful audit process.
• • Analyzing and managing delegated provider data is central to this position. You will be responsible for interpreting complex datasets, identifying trends, and providing actionable insights to optimize our delegation management processes. This data-driven approach will enable us to make informed decisions regarding provider selection, retention, and performance monitoring.
• • Maintaining a current and thorough working knowledge of all applicable regulatory credentialing requirements for medical, dental, and behavioral delegation is non-negotiable. The healthcare landscape is constantly evolving, and you will be expected to stay abreast of changes in regulations from bodies like NCQA and Medicare, ensuring our practices remain compliant and industry-leading.
• • Effective collaboration is paramount. You will work closely with delegated groups, compliance and legal departments, direct credentialing teams, contracting specialists, and other matrix partners. Building strong working relationships and fostering open communication channels will be essential for resolving issues, driving initiatives, and achieving shared objectives.
• • A fundamental understanding of the operations of key matrix partners within The Cigna Group is also required. This cross-functional awareness will enable you to anticipate needs, identify potential challenges, and contribute to more integrated and efficient workflows across the organization.
• • You will provide expert support and act as a subject matter expert for various projects, contributing your specialized knowledge to enhance our credentialing processes and strategies. This may involve participating in the development of new policies, evaluating new technologies, or leading specific initiatives aimed at improving efficiency and compliance.
• • Finally, you will perform other related duties as assigned, demonstrating flexibility and a willingness to contribute wherever your skills are most needed to support the team and the company's mission. This role offers a unique opportunity to make a tangible impact on the quality and accessibility of healthcare services provided by The Cigna Group.