Credentialing Specialist

Aetna Medicaid Administrators

2d • $17 - $34

About The Position

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position Summary Completes credentialing and recredentialing verification process for Medicaid providers Reviews and validates provider information against business and credentialing requirements, following company policies, state regulations and accrediting body standards. Performs extensive research and analysis of sensitive provider issues Meets state and departmental turn around times What you will do The Credentialing Specialist is responsible for managing and maintaining the credentialing process for healthcare providers who are joining, the network. This role ensures that all providers meet regulatory, payer, and organizational requirements, and that all credentialing activities are completed timely and accurately.

Requirements

• 1-3 years of credentialing experience
• 1-3 years of healthcare experience
• Good communication skills - written and verbal

Nice To Haves

• Production Environment
• Strong desk management skills
• Performs data collection, analytical research, and analysis
• Ability to manage multiple processes
• Experience with Salesforce, Microsoft Office, and EPDB

Responsibilities

• Completes credentialing and recredentialing verification process for Medicaid providers
• Reviews and validates provider information against business and credentialing requirements, following company policies, state regulations and accrediting body standards.
• Performs extensive research and analysis of sensitive provider issues
• Meets state and departmental turn around times
• Managing and maintaining the credentialing process for healthcare providers who are joining, the network.
• Ensures that all providers meet regulatory, payer, and organizational requirements, and that all credentialing activities are completed timely and accurately.

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

What This Job Offers

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