Credentialing Specialist II - Evernorth

As a valued member of the credentialing team, you will play an important role in supporting timely, accurate enrollment and credentialing processes that enable access to pharmacy services. In this role, you will collaborate across teams and with external partners to ensure compliance, strengthen relationships, and support operational excellence. Your attention to detail, organization, and commitment to service will directly contribute to improved access and outcomes.

Responsibilities

• Prepare and manage enrollment and credentialing applications for health plans, PBMs, Medicaid, and other payors.
• Oversee credentialing and re-credentialing processes to ensure compliance with regulatory, accreditation, and payer requirements.
• Track and manage credentialing timelines, ensuring all submissions and follow-ups are completed on schedule.
• Review documentation for accuracy and completeness, identifying and resolving gaps proactively.
• Build and maintain strong relationships with payors, managed care organizations, and state agencies to facilitate timely approvals.
• Partner with billing and operations teams to resolve credentialing-related reimbursement and contract issues.
• Support network contracting activities by communicating with payors and submitting required documentation.
• Provide guidance and support to internal teams regarding credentialing processes and requirements.
• Identify opportunities for process improvement and contribute to performance enhancement initiatives.
• Maintain confidentiality of all sensitive information and adhere to compliance standards.

Required Qualifications

• Minimum of 5 years of experience in credentialing within healthcare, including experience with health plans, PBMs, or Medicaid.
• Strong understanding of credentialing, enrollment, and regulatory requirements.
• Excellent organizational and time management skills with ability to meet deadlines.
• Strong communication skills and ability to collaborate across teams.
• Proficiency in Microsoft Office, including Word, Excel, and Outlook.

Preferred Qualifications

• Associate’s degree in healthcare or related field, or equivalent experience.
• Experience supporting pharmacy or specialty pharmacy operations.

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. This role is also anticipated to be eligible to participate in an incentive compensation 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 The Cigna Group Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. 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 need a reasonable accommodation to complete the online application process, please email [email protected] for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes. 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. Apply tot his job Apply To this Job