Credentialing Specialist

CVS Health • Farmers Branch, TX

4d • $17 - $28 • Hybrid

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. CVS Business Unit: Signify Health Location / Logistics: Hybrid - Based in Signify HQ in Farmers Branch, Dallas TX. Preference is given to applicants who are able to commute on regular basis to Signify HQ located at 4055 Valley View Lane in Dallas, TX. Position Summary The Credentialing Specialist ensures clinicians successfully pass the Signify Health credentialing process. This role is responsible for assisting clinicians with the completion of their credentialing applications , performing primary source verifications , and maintaining the MD Staff credentialing database. The Specialist must ensure all credentialing functions comply with internal policies, client health plan contracts, URAC guidelines, NCQA standards, and applicable state and federal requirements. This position reports to the Credentialing Supervisor.

Requirements

• High school diploma or up to 1 year of equivalent experience.
• 1-3 years of successful work experience in a credentialing role/department.
• Intermediate skills with Google Suites.
• Must be familiar with NCQA accreditation standards.
• Demonstrate active listening skills and the ability to provide and receive constructive feedback
• Strong interpersonal skills, with the ability to build rapport and productive relationships with internal and external stakeholders

Nice To Haves

• Obtain NAMSS Certification as a Certified Provider Credentialing Specialist (CPCS) 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 the timely processing of credentialing files in accordance with NCQA policies.
• Query appropriate organizations and evaluate responses to ensure provider compliance with NCQA standards.
• Maintain copies of current state licenses, DEA certificates, malpractice coverage, and other required credentialing documents for all providers.
• Review all background checks, drug tests, and TB screenings and record the results.
• Assemble all 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 the ongoing monitoring of contracted clinicians.
• Utilize the MD Staff credentialing database to perform queries, generate reports, and optimize efficiency.
• Provide administrative support to department leadership and both internal and external stakeholders.
• Maintain professionalism at all times and provide timely, professional responses to all emails.
• Actively demonstrate teamwork and assist with special projects.
• Responsible for the security and privacy of any protected health information (PHI) accessed during work activities.

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