Credentialing Specialist

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.

• → 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 appropriate organizations 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 all background checks, drug tests, and TB screenings and record the results.
   
• →Assemble all 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 the ongoing monitoring of contracted clinicians.
   
• →Utilize the MD Staff credentialing database to perform queries, generate reports, and optimize efficiency.
   
• →Provide administrative support to department leadership and both internal and external stakeholders.
   
• →Maintain professionalism at all times and provide timely, professional responses to all emails.
   
• →Actively demonstrate teamwork and assist with special projects.
   
• →Responsible for the security and privacy of any protected health information (PHI) accessed during work activities. 

• 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 organize and prioritize workload and day-to-day tasks.

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual full-time 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 short-term 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.