Credentialing Specialist

CVS Health•Farmers Branch, TX

10d•$17 - $28

About The Position

The Credentialing Specialist ensures clinicians successfully complete the Signify Health credentialing process. The role assists clinicians with credentialing applications, performs primary source verifications, and maintains the MD Staff credentialing database. Credentialing functions must comply with internal policies, client health plan contracts, URAC guidelines, NCQA standards, and applicable state and federal requirements. The position reports to the Credentialing Supervisor. The position is based at the Farmers Branch Office in Dallas, Texas. A hybrid arrangement is preferred for candidates within 40 miles of the Dallas-Fort Worth office, with onsite work expected at least once per month. Candidates outside the local area may be considered for fully remote work. Candidates across the United States may be considered, with work schedules aligned to the Central time zone. This is a full-time position with 40 anticipated weekly hours. The stated base pay range is $17.00–$28.46 per hour. The position is eligible for a CVS Health bonus, commission, or short-term incentive program, as well as a benefits package that includes medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, subject to eligibility.

Requirements

1–3 years of successful work experience in a credentialing role or department.
Intermediate skills with Google Suites.
Familiarity with NCQA accreditation standards.
Active listening skills and the ability to provide and receive constructive feedback.
Strong interpersonal skills and the ability to build rapport and productive relationships with internal and external stakeholders.
High school diploma or up to one year of equivalent experience.

Nice To Haves

Obtain NAMSS Certified Provider Credentialing Specialist (CPCS) certification within two years of eligibility to certify.
Working knowledge of problem-solving and decision-making skills.
Ability to organize and prioritize workload and day-to-day tasks.

Responsibilities

Review and process credentialing and re-credentialing files.
Establish and maintain a system for timely processing of credentialing files in accordance with NCQA policies.
Query appropriate organizations and evaluate responses to ensure provider compliance with NCQA standards.
Maintain current state licenses, DEA certificates, malpractice coverage, and other required credentialing documents for all providers.
Review background checks, drug tests, and TB screenings and record the results.
Assemble verified information and prepare files for presentation to the Credentialing Committee.
Verify providers' requirements for approval to work in specific states and plans.
Assist with ongoing monitoring of contracted clinicians.
Use the MD Staff credentialing database to perform queries, generate reports, and optimize efficiency.
Provide administrative support to department leadership and internal and external stakeholders.
Maintain professionalism and provide timely, professional responses to emails.
Demonstrate teamwork and assist with special projects.
Protect the security and privacy of protected health information (PHI) accessed during work activities.