Senior Credentialing Specialist

CVS Health•Farmers Branch, TX

1d•$19 - $35•Onsite

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 Summary: The Network Activation Sr. Credentialing Specialist supports network operations, compliance monitoring, and provider data integrity. The role ensures network providers comply with company, state, and regulatory body requirements, including NCQA, URAC, Medicare, Medicaid, and delegation agreements, by reviewing, validating, and analyzing provider information. The Sr. Credentialing Specialist also drives process improvements, handles stakeholder inquiries, and provides administrative and operational support to meet departmental needs.

Requirements

3-5 years of successful work experience in a Network Activation or credentialing role/department
High School Diploma

Nice To Haves

Candidates local to the Dallas area who can commute to the Signify Health headquarters in Farmers Branch are preferred.
NAMSS Certification as a Certified Provider Credentialing Specialist (CPCS) within 2 years of eligibility to certify.
Intermediate skills in Google Suite Applications such as Gmail, Google Calendar, Google Sheets and Slide Presentations

Responsibilities

Support diverse network activation projects and operations to ensure department-wide compliance and efficiency.
Act as primary liaison for clinicians and internal departments to support communication, address inquiries, and resolve issues.
Conduct ongoing verification and monitoring of state licenses, exclusion lists, DEAs, board certifications, and enrollment data to validate provider standing.
Manage clinician enrollment, state licensure applications, and renewals according to state and federal guidelines.
Ensure strict adherence to business, state, and accrediting body regulatory requirements, including NCQA, URAC, Medicare, Medicaid, and delegation agreements.
Maintains data tracking and facilitates provider data integrity across organizational units.
Prepare education and training materials on Network Activation policies, procedures, and quality standards, and conduct training to enforce standards.
Drive process improvement initiatives, manage stakeholder inquiries, and execute administrative and operational support to accommodate flexible departmental needs.