Sr Cdr,Cred & Physcian Mgt

CVS Health•Island, KY

1d•$19 - $39

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 Credentialing Coordinator manages the initial credentialing and re-credentialing process for nurse practitioners, physician assistants, behavioral health providers, and physicians. This role helps ensure credentialing activities are completed accurately, on time, and in compliance with Joint Commission, NCQA, and URAC standards. The coordinator also monitors expirable credentials, supports compliance oversight, and maintains accurate provider documentation.

Requirements

Minimum of three years of healthcare industry experience, including credentialing experience.
Proficient in quantitative data analysis
Understanding of Joint Commission Accreditation, NCQA and URAC credentialing standards.
Ability to function independently and utilize critical thinking skills to accomplish goals and objectives
Meticulous attention to detail
Effective communication skills; verbal and written
Strong interpersonal skills including the ability to work well with internal and external stakeholders
Strong organizational skills and the ability to multitask
Competent user of Microsoft Office, Outlook, Word, and Excel

Nice To Haves

Certified Billing and Coding Specialist (CBCS)
NAMSS Certified Professional Credentialing Specialist (CPCS) certification.
Associates or bachelor’s in business highly preferred
MDStaff experience preferred

Responsibilities

Process initial and re-credentialing applications for NP, PA, behavioral health, and physician providers in accordance with MinuteClinic credentialing policies and program requirements.
Track expired licensure reports, database tasks, system updates, and weekly leadership reporting.
Manage Epic access for providers with noncompliant licensure or board certification status.
Perform sanctions and compliance monitoring and escalate undisclosed negative findings to the Credentialing Manager and Revenue Director.
Complete malpractice insurance verification requests according to internal guidelines.
Maintain provider and physician SharePoint sites and communicate provider status updates to leadership and internal teams to support timeline adherence.
Submit system access requests after credentialing approval and clinic eligibility confirmation.
Assist the payer enrollment team with resolving payer claim issues as needed.
Review provider and clinic change or termination reports and update the database as appropriate.
Process provider name changes in accordance with MinuteClinic policies and procedures.
Maintain provider credentialing grids and notify appropriate teams of updates.
Review and distribute incoming mail as needed.
Support payer audits in alignment with MinuteClinic, Joint Commission, and NCQA requirements.
Ensure provider files contain current and complete information and documentation.
Inform system analysts and leadership of system interruptions, state agency updates, and password changes.
Identify opportunities to improve processes and increase system efficiencies.
Participate actively in team meetings.
Promote a positive team environment and work effectively in a fast-paced setting.
Demonstrate understanding of initial credentialing and re-credentialing practices for medical professionals including primary source verification methods, compliance monitoring and expirable management.