Credentialing Specialist

CVS Health • Farmers Branch, TX

9d • Hybrid

About The Position

The Credentialing Specialist ensures clinicians successfully complete the Signify Health credentialing process. The role helps clinicians complete credentialing applications, performs primary source verifications, and maintains the MD Staff credentialing database. Credentialing work 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 role is based around the Farmers Branch office in Dallas, Texas. Hybrid work 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 fully remote. Candidates across the United States will be considered, with work schedules aligned to the Central time zone.

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 1 year of equivalent experience.

Nice To Haves

• Obtain NAMSS Certified Provider Credentialing Specialist (CPCS) certification within 2 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 copies of state licenses, DEA certificates, malpractice coverage, and other required credentialing documents for 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 health plans.
• Assist with ongoing monitoring of contracted clinicians.
• Use the MD Staff credentialing database to perform queries, generate reports, and improve efficiency.
• Provide administrative support to department leadership and internal and external stakeholders.
• Maintain professionalism and provide timely, professional email responses.
• Demonstrate teamwork and assist with special projects.
• Protect the security and privacy of protected health information accessed during work activities.

Benefits

• Medical coverage
• Dental coverage
• Vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources, based on eligibility
• Eligible for a CVS Health bonus, commission, or short-term incentive program in addition to base pay

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED