Sr. Credentialing Specialist at CVS Health

Dallas, Texas, United States

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Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

2+ years of experience in healthcare operations or credentialing, preferably with knowledge of processing credentialing applications
Experience with Credentialing Database Systems, preferably MD-Staff
Strong organizational skills with keen attention to detail
Proficiency in systems such as MD-Staff, Google Suite, PowerBi, and Microsoft Office Suite
Excellent verbal and written communication skills
Ability to manage multiple deadlines and work independently in a fast-paced environment

Responsibilities

Thoroughly review and validate all provider information to ensure strict adherence to internal company policies, state regulations, and accrediting body standards
Conduct in-depth research and complex analysis on sensitive provider issues, proactively address data integrity concerns by preparing and reviewing completed investigative files, including complex, risk-sensitive credentialing verifications
Proactively identify, propose, and implement enhancements and solutions to continuously develop and improve credentialing processes and workflows
Act as the initial contact for providers and committee members, expertly handling their inquiries and resolving issues related to both credentialing and data management
Execute both routine and non-routine business support tasks for the Credentialing function under limited supervision, adhering to established procedures and protocols and escalating deviations to management
Provide essential administrative support to the Credentialing Committee Liaison, including managing application assignments, distributing official outcome letters, and publishing appointments
Maintain organized data collections, tracking, and reporting systems
Conduct and organize continuous audits to rigorously assess adherence to standards, expected outcomes, and deliverable schedules
Create and present impactful education and training on credentialing policies and procedures to both internal teams and healthcare providers
Cultivate and maintain strong, effective working relationships with team members to collaboratively discuss credentialing requirements, swiftly resolve issues, and prevent service delays

Skills

Key technologies and capabilities for this role

CredentialingComplianceProvider ValidationRegulatory AdherenceData IntegrityInvestigative AnalysisProcess ImprovementAuditsTrainingAdministrative SupportCommittee Liaison

Questions & Answers

Common questions about this position

What is the employment type for this Sr. Credentialing Specialist position?

This is a full-time position.

Is this Sr. Credentialing Specialist role remote or office-based?

This information is not specified in the job description.

What key skills are needed for the Sr. Credentialing Specialist role?

Key skills include thorough review and validation of provider information, in-depth investigative analysis, process improvement, inquiry management, administrative support, and conducting audits and training.

What is the company culture like at CVS Health for this role?

The culture emphasizes building a world of health with dedicated, purpose-driven colleagues passionate about transforming health care through connected, convenient, and compassionate service, with close team collaboration to resolve problems and avoid disruptions.

What makes a strong candidate for the Sr. Credentialing Specialist position?

Strong candidates excel in compliance validation, investigative analysis of sensitive provider data, process improvements, handling inquiries, providing administrative support under limited supervision, and conducting audits and training.

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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