Sr. Credentialing Specialist

CVS Health•Farmers Branch, TX

2d•$19 - $35•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. Position Summary The Senior Credentialing Specialist ensures all credentialing functions comply with internal policies, client contracts, URAC guidelines, NCQA standards, and all applicable state and federal requirements. This position provides guidance to staff and customers, helps manage workflow improvement projects, and handles non-routine business support tasks with limited supervision.

Requirements

3+ years of successful work experience, preferably in a credentialing role/department.
Must be familiar with NCQA accreditation standards.
Working knowledge of problem-solving and decision-making skills.
Demonstrates active listening skills and strong interpersonal skills, with the ability to build rapport and productive relationships with internal and external stakeholders
Strong organizational skills- attention to detail
Intermediate skills with Google Suites

Nice To Haves

NAMSS Certification as a Certified Provider Credentialing Specialist (CPCS), or ability to obtain within 2 years of eligibility.
Demonstrated ability to organize and prioritize workload and day-to-day tasks

Responsibilities

Serve as a subject matter expert on credentialing for internal staff and external customers.
Prepare and provide education and training to Credentialing Specialists on credentialing policies and internal processes.
Organize and conduct ongoing audits to evaluate compliance with standards, outcomes, and deliverable timelines.
Review and process new clinician credentialing and re-credentialing files if required based on business needs.
Perform primary source verifications by querying appropriate organizations (e.g., state boards, NPDB) and evaluating responses to ensure compliance.
Assemble all verified information and prepare files for presentation to the Credentialing Committee.
Maintain accurate copies of current state licenses, DEA certificates, malpractice coverage, and other required credentialing documents.
Review all background checks, drug tests, and TB screenings and record the results.
Utilize the MD Staff credentialing database to perform queries, generate reports, and optimize efficiency.
Assist with the ongoing monitoring of contracted clinicians.
Maintain responsibility for the security and privacy of any protected health information (PHI) accessed during work activities.
Provide administrative support to department leadership and stakeholders.
Actively demonstrate teamwork and assist with special projects.