The Credentialing Coordinator is responsible for initial credentialing and re-credentialing nurse practitioners, physician assistants and physicians in a compliant and timely manner; monitor expired credentials and compliance monitoring in accordance with Joint Commission accreditation, NCQA and URAC credentialing standards as required. The position responds to, conducts, and documents corporate audit and delegation activities to comply with vendor, corporate and health plan contractual requirements. Additionally, this position collaborates with the network credentialing reporting team to ensure the thoroughness and accuracy of all customer deliverables including corrective action plans. This position supports the corporate-wide audit deliverables.
• Responsible for the timely and accurate processing of all providers including NP's/PA's/MD's initial and Re-credentialing applications according to the Minute Clinic Provider Credentialing Program
• Monitor Expired licensure reporting , data base tasks and maintain system updates and weekly reporting to leadership
• Works with team members to ensure annual audits, pre-assessments, provider rosters, file reviews, and reports are accurate, complete, and meet vendor deliverable deadlines. Updates and maintains delegated credentialing tracker tool to track internal performance.
• Responds to corporate and payer audit requests as directed. Is a member of the corporate audit workgroup and assists in responding to requests for information. Documents task completion as directed.
• Performs reviews and quality controls of NCQA/URAC credentialing accreditation documentation including staging of documents, file exchanges, credential file preparation, etc.
• Manage Epic access for any providers that have out of compliance licensure and/or board certification.
• Conduct sanctions and compliance monitoring and alert Credentialing Manager and Revenue Director of any undisclosed negative findings
• Process malpractice insurance verification requests according to internal policies
• Maintain the provider and physician SharePoint sites and Communicate provider status's with leadership and other internal teams to meet timelines
• Submit system access requests upon credentialing approvals/clinic eligibility
• Support the payer enrollment team as needed to resolve any payer claim issues
• Monitor Provider and Clinic change/Termination reports and update data base accordingly
• Process Name changes according to Minute Clinic policies and procedures
• Daily maintenance of provider credentialing grids with notification to appropriate teams
• Review and distribute all incoming mail as needed
• Support Payer Audits in accordance with Minute Clinic, Joint Commission and NCQA requirements
• Maintain provider files with the most current information/documentation
• Notify system analyst and leadership of any system and state agencies interruptions/updates/password changes
• Make recommendations for process improvement and system efficiencies
• Attend and engage in all team meetings
• Model a positive attitude in interactions with team members
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.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
For more detailed information on available benefits, please visit
Demonstrated understanding of initial credentialing and re-credentialing practices for medical professionals including primary source verification methods, compliance monitoring and expireables management.
• Understanding of Joint Commission Accreditation, NCQA and URAC credentialing standards.
• Data analysis experience and experience developing and analyzing reports
• Ability to function independently and utilize critical thinking skills to accomplish goals and objectives
• Effective communication skills; verbal and written
• Strong interpersonal skills including the ability to work well with internal and external stakeholders
• Strong organizational skills and the ability to multitask
• Competent user of Microsoft Office, Outlook, Word, and Excel
• A minimum of 3 years experience in the healthcare industry with experience in credentialing and payer audit
NAMSS Certified Professional Credentialing Specialist (CPCS) certification
Bachelor's or Associate's degree on Business Administration or similar
Verifiable High School Diploma or GED is required
Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. 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.
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