Credentialing Specialist
Credentialing Specialist
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$ 17 - 28
1 Vacancy
Job Description
At CVS Health were building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.
As the nations leading health solutions company we reach millions of Americans through our local presence digital channels and more than 300000 purposedriven colleagues caring for people where when and how they choose in a way that is uniquely more connected more convenient and more compassionate. And we do it all with heart each and every day.
Position Summary
The Credentialing Coordinator is responsible for ensuring clinicians successfully pass through the Signify Health credentialing process. Credentialing functions include but are not limited to assisting clinicians with the completion of their credentialing applications performing primary source verifications and updating and maintaining MD Staff credentialing database in accordance with internal policies and procedures client health plan contracts URAC guidelines and applicable state and federal requirements.
This role will report to our Credentialing Manager.
Preference is given to candidates who are local to Dallas area and able to commute to the Signify Health HQ offices in Farmers Branch at 4055 Valley View Lane.
What will you do
- Queries appropriate organizations and evaluates responses to ensure provider compliance with NCQA standards
- Establishes and maintains a system for timely processing of credentialing/recredentialing files in accordance with NCQA policies
- Maintain up to date credentialing database and ensuring data accuracy.
- Review and process credentialing and recredentialing files
- Maintains copies of current state licenses DEA certificates malpractice coverage and any other required credentialing documents for all providers.
- Maintains professionalism at all times when communicating credentialing and/or background concerns with any clinician
- Assembles all verified information and prepares files for presentation to the Credentialing Committee
- Assist with ongoing monitoring of contracted clinicians
- Reviews all background checks drug tests and TB screenings and record results
- Utilizes the MD Staff credentialing database optimizing efficiency and performs query report and document generation
- Assist with special projects
- Be familiar with accreditation standards
- Verify providers requirements for approval to work in specific states and plans.
- Provides administrative support to leadership within the department and both internal and external stakeholders
- Actively demonstrates teamwork at all times
- Respond to monthly audits
- Respond to requests from various internal departments
- Responsible for the security and privacy of any and all protected health information that may be accessed during normal work activities
Basic Qualifications
- High School Diploma
- 35 years of successful work experience in a credentialing role/department
- 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
- Preference is given to candidates who are local to Dallas TX and able to commute hybrid to our offices in Farmers Branch
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$17.00 $28.46This pay range represents the base hourly rate or base annual fulltime salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience education geography and other relevant factors. This position is eligible for a CVS Health bonus commission or shortterm incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers patients members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in our comprehensive and competitive mix of pay and benefits investing in the physical emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages our great benefits include:
Affordable medical plan options a 401(k) plan (including matching company contributions) and an employee stock purchase plan.
Nocost 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.
For more information visit anticipate the application window for this opening will close on: 04/16/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal state and local laws.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
