Skip to main content

A new day in healthcare. Together, CVS Health and Aetna help people on their path to better health.

Credentialing Processor

Primary Location: Sugar Land, TX
Additional Locations: TX-Sugar Land
Reviews, analyzes, evaluates, validates provider/producer information against business/credentialing requirements and maintains information in Credentialing Management data bases.

Fundamental Components:
Reviews (re)credentialing data for completeness, accuracy and conducts research pertaining to missing data.(*) Performs accurate and timely baseline demographic transaction updates in provider/producer system applications. Analyzes data to identify variances in information furnished by providers/producers against primary verification sources.Utilizes systems to maintain credential files, EPC and CARDS to track queries, documentation of phone calls, correspondence, completed applications, and outcomes.Contacts providers/producers to clarify and resolve data quality issues. Identifies potential risk situations, collects pertinent information and completes investigation.Reports results of credentials findings and document further action needed.Protects the confidentiality and integrity of provider/producer data files. Conducts and manages ongoing review of provider/producer compliance to contract requirements. Researches, investigates, approves and coordinates resolution of business exceptions with internal and external constituents. Identifies and appropriately escalates data transaction and credentialing issues that might potentially have significant adverse impact on service levels. Monitors and reports data elements for quality against standards. Manages incoming requests for provider/producer application and status requests, utilizing systems to determine eligibility for network participation. Performs recredentialing application management process for all outstanding applications at risk of non-compliance. Utilizes data systems to access information to respond to customer service call line questions maintaining service call TAT, ASA and high quality customer satisfaction goals.

Background Experience:
College degree or equivalent work experience preferred.High School Diploma or G.E.D.

Additional Job Information:
Ability to work reliably, prudently and tactfully with confidential information.Proficient computer skills, including proficiency in Microsoft Word and Excel.Strong verbal and written communication skills.

Required Skills:
General Business - Applying Reasoned Judgment, General Business - Demonstrating Business and Industry Acumen, Service - Demonstrating Service Discipline

Desired Skills:
General Business - Communicating for Impact, General Business - Maximizing Work Practices, Service - Providing Solutions to Constituent Needs

Functional Skills:
Administration / Operation - Data Entry, Communication - Employee communications, Customer Service - Customer service - production environment, Information Technology - Research

Technology Experience:
Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel

Potential Telework Position:

Percent of Travel Required:

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

Benefit Eligibility:
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Candidate Privacy Information:
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Click To Review Our Benefits (PDF)


Jobs for you

Recently Viewed Jobs

You do not have any recently viewed jobs

Your Saved Jobs

You do not have any saved jobs

Sign up for Job Alerts

Join our Talent Community

At Aetna, we are pioneering a total approach to health and wellness and we need talented candidates like you to join our team. Become a member of our talent community to be the first to know about career initiatives that match your skills and interests as they become available, in addition to details on upcoming events, networking opportunities, and news about Aetna.

Join Our Talent Community

Sign up to receive information about job openings that are tailored to your skills and interests. Plus, get the latest career news from Aetna.