Credentialing Specialist at CVS Health

Dallas, Texas, United States

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Not SpecifiedCompensation

Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

1-3 years of successful work experience in a credentialing role/department
Intermediate skills with Google Suites
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
High school diploma or up to 1 year of equivalent experience

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 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

Skills

Key technologies and capabilities for this role

CredentialingPrimary Source VerificationMD StaffNCQA StandardsURAC GuidelinesDatabase ManagementBackground ChecksDEA VerificationMalpractice CoverageProvider Compliance

Questions & Answers

Common questions about this position

What experience is required for the Credentialing Specialist role?

1-3 years of successful work experience in a credentialing role or department is required, along with intermediate skills in Google Suites and familiarity with NCQA accreditation standards.

What are the key soft skills needed for this position?

The role requires active listening skills, the ability to provide and receive constructive feedback, strong interpersonal skills to build rapport, and professionalism in communications.

Is this a remote position or does it require office work?

This information is not specified in the job description.

What is the salary or compensation for this role?

This information is not specified in the job description.

What makes a strong candidate for this Credentialing Specialist position?

Candidates with 1-3 years of credentialing experience, NCQA familiarity, Google Suites proficiency, strong interpersonal skills, and pursuit of NAMSS CPCS certification stand out.

CVS Health

Comprehensive pharmacy and healthcare services

About CVS Health

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.

Woonsocket, Rhode IslandHeadquarters

1963Year Founded

DEBTCompany Stage

Healthcare, Consumer GoodsIndustries

10,001+Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Company Equity

Wellness Program

Professional Development Budget

Paid Vacation

Paid Holidays

Risks

Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.

The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.

The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.

Differentiation

CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.

The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.

CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.

Upsides

Expansion of telehealth services allows CVS to reach more patients remotely.

Increased consumer interest in wellness boosts demand for CVS's health-related products.

The trend towards value-based care aligns with CVS's integrated healthcare approach.

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