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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. CVS Business Unit: Signify Health Location / Logistics: Hybrid - Based in Signify HQ in Farmers Branch, Dallas TX. Preference is given to applicants who are able to commute on regular basis to Signify HQ located at 4055 Valley View Lane in Dallas, TX. Position Summary The Credentialing Specialist ensures clinicians successfully pass the Signify Health credentialing process. This role is responsible for assisting clinicians with the completion of their credentialing applications , performing primary source verifications , and maintaining the MD Staff credentialing database. The Specialist must ensure all credentialing functions comply with internal policies, client health plan contracts, URAC guidelines, NCQA standards, and applicable state and federal requirements. This position reports to the Credentialing Supervisor.
Job Responsibility:
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
Requirements:
High school diploma or up to 1 year of equivalent experience
1-3 years of successful work experience in a credentialing role/department
Intermediate skills with Google Suites
Must be familiar with NCQA accreditation standards
Demonstrate active listening skills and the ability to provide and receive constructive feedback
Strong interpersonal skills, with the ability to build rapport and productive relationships with internal and external stakeholders
Nice to have:
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
What we offer:
Affordable medical plan options
401(k) plan (including matching company contributions)
employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching