The Credentialing Analyst position is responsible for the oversight and administration of the pharmacy re-credentialing activities. The functions of this position provide management with assurance that the re-credentialing program for pharmacy network providers aligns with business requirements. Specifically, this position supports compliance with the delegated credentialing responsibilities of our Managed Medicaid clients in accordance with Title 42 of the Code of Federal Regulations, Chapter IV Medicare & Medicaid Services, Department of Health & Human Services, Subchapter C, Part 455, Subpart B and E. This position has heavy emphasis on data management and reporting.
Administration of the pharmacy survey and re-credentialing process:
•Update, test, and maintain the re-credentialing survey questionnaire software tool
•Interface with internal partners to assess, develop, and redefine data integrity of the survey to meet our business requirements
•Coordinate and communicate timely and accurate delivery of survey to the pharmacy community
•Monitor survey response progress, respond to pharmacy questions, provide pharmacies with technical support and troubleshooting
•Outreach to pharmacy community as required by the business process
•Review and prepare survey data for upload to pharmacy master
•Data Reporting - analyze data and prepare reports for internal and external consumption
•Administer, track, and report the credentialing validation process
2+ years working experience in Advanced level Microsoft Office – specifically MS Excel
• 2+ years working experience of MS Access
*Self Disciplined with strong organization skills, ability to meet strict deadlines
*Proactive work ethic and self motivated; ownership of the position , and a positive attitude
*Must be able to write clear and concise documentation.
*Proven ability to successfully manage and track multiple projects simultaneously.
*High focus on detail
*Advanced level in Microsoft Office - Excel, Access, Word.
* SQL Management Studio
*Demonstrated proficiency in documenting and writing of work instructions, policies and procedures
Bachelor Degree is required
It's a new day in health care.
Combining CVS Health and Aetna was a transformative moment for our company and our industry, establishing CVS Health as the nation's premier health innovation company. Through our health services, insurance plans and community pharmacists, we're pioneering a bold new approach to total health. As a CVS Health colleague, you'll be at the center of it all.
We offer a diverse work experience that empowers colleagues for career success. In addition to skill and experience, we also seek to attract and retain colleagues whose beliefs and behaviors are in alignment with our core values of collaboration, innovation, caring, integrity and accountability.
CVS Health is an equal opportunity/affirmative action employer. Gender/Ethnicity/Disability/Protected Veteran – we highly value and are committed to all forms of diversity in the workplace. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities. We comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT. We provide reasonable accommodations to qualified individuals with disabilities. If you require assistance to apply for this job, please contact our Advice and Counsel Reasonable Accommodations team. Please note that we only accept applications for employment via this site.
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