Provider Enrollment Coordinator
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. Position Introduction and Overview: This role will report to our Provider Enrollment Supervisor Responsible for reviewing and processing credentialing applications and supporting documentation for the purpose of enrolling individual physicians and physician groups in Medicaid and Medicare. Responsible for accurate and timely processing of Part B provider enrollment applications.
Requirements
- Knowledge of health plan and governmental payer credentialing, enrollment and requirements acquired through completion of a CPCS certification course, or sufficient job-related experience with intent to pursue certification.
- Knowledge of PECOS and State Medicaid Enrollment applications
Nice To Haves
- Experience with MD Staff credentialing and enrollment software preferred
- Knowledge of standards interpretation as related to NCQA
- 3 years of experience in a centralized credentialing office and direct provider enrollment experience, such as credentialing or file maintenance, preferred with experience in Word and Excel
Responsibilities
- Ability to work within a deadline-intense environment.
- Interact professionally with providers and staff representatives to provide information on any necessary documentation required for processing.
- Plan, prioritize, organize and complete work to meet established objectives.
- Track and follow up with providers for timely return of all required documents and applications.
- Assists in synchronization of data among multiple systems
- Validates the data to be housed on provider databases and ensuring adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing
- Display in-depth knowledge of and execute all standard operating procedures (SOPs) as well as communicating issues, trends, concerns and suggestions to leadership.
- In-depth working knowledge of the various payer applications associated and the workflow process.
- Ensure all workflow items are completed within the set turn-around-time, meeting quality expectations.
Benefits
- This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
- Additional details about available benefits are provided during the application process and on Benefits Moments.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
No Education Listed
Number of Employees
5,001-10,000 employees
