Description
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 colleagues who care deeply, innovate with purpose, hold themselves accountable and prioritize safety and quality in everything they do.
Job Details
- Location: Farmers Branch Office, 4055 Valley View Lane, Dallas, TX
- Work Arrangement: Hybrid preferred for candidates located within 40 miles of the Dallas-Fort Worth office, with an expectation to work onsite at least once per month. Fully remote consideration is available for candidates outside the local area.
- Employment Type: Full-time
- Anticipated Weekly Hours: 40
Position Summary
The Credentialing Specialist ensures clinicians successfully pass the Signify Health credentialing process. This role assists clinicians with completing their credentialing applications, performs primary source verifications, and maintains the MD Staff credentialing database.
Key Responsibilities
- Review and process credentialing and re-credentialing files
- Establish and maintain a system for the timely processing of credentialing files in accordance with NCQA policies
- Query organisations and evaluate responses to ensure provider compliance with NCQA standards
- Maintain copies of current state licenses, DEA certificates, malpractice coverage, and other required credentialing documents for all providers
- Review background checks, drug tests, and TB screenings and record the results
- Assemble verified information and prepare files for presentation to the Credentialing Committee
- Verify providers' requirements for approval to work in specific states and plans
- Assist with ongoing monitoring of contracted clinicians
- Utilise the MD Staff credentialing database to perform queries, generate reports, and optimise efficiency
- Provide administrative support to department leadership and internal and external stakeholders
- Maintain professionalism and provide timely, professional responses to emails
- Actively demonstrate teamwork and assist with special projects
- Ensure the security and privacy of protected health information (PHI) accessed during work activities
Required Qualifications
- 1-3 years of successful work experience in a credentialing role/department
- Intermediate skills with Google Suites
- Familiarity with NCQA accreditation standards
- Active listening skills and ability to provide and receive constructive feedback
- Strong interpersonal skills, with the ability to build rapport and productive relationships with internal and external stakeholders
Preferred Qualifications
- Obtain NAMSS Certification as a Certified Provider Credentialing Specialist (CPCS) within 2 years of eligibility to certify
- Working knowledge of problem-solving and decision-making skills
- Ability to organise and prioritise workload and day-to-day tasks
Education
- High school diploma or up to 1 year of equivalent experience
Pay Range
$17.00 - $28.46
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. Benefits include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.