Credentialing Specialist

Credentialing Specialist

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 Job Summary:

The Credentialing Specialist is responsible for overseeing and managing the administrative and compliance processes related to the collaboration agreements between Nurse Practitioners (NPs), Physician Assistants (PAs), and their designated supervising or collaborating physicians.

This role ensures alignment with state laws, regulatory standards, and organizational policies while supporting timely onboarding, renewals, and effective communication between all stakeholders. Location / Logistics: This role is open to remote candidates but preference is for candidates in Dallas, TX area that can work Hybrid every other Tuesday in office. (In office schedule is subject to change based on business needs.) Signify Dallas offices are located at: 4055 Valley View Ln #700, Dallas, TX 75244

Roles & Responsibilities:

• Conducts primary source verification, collects and validates documents to ensure accuracy of all credentialing elements; assesses completeness of information and qualifications relative to credentialing standards and Signify Health criteria, while maintaining the confidentiality of all protected health information that may be accessed.
• Identifies analyzes and resolves extraordinary information, discrepancies, time gaps, and other idiosyncrasies that could adversely impact the ability to credential and enroll practitioners; discovers and conveys problems to Credentialing Manager/Supervisor/Director.
• Communicates clearly with providers, internal/external clients, and all Signify Health staff as needed to provide timely responses upon request on day-to-day credentialing issues as they arise.
• Maintain knowledge of state and federal regulations, accreditation standards, and client requirements to ensure full compliance across all credentialing activities.
• Develop and implement strategies for tracking clinician eligibility, ensuring that all necessary documentation is submitted, verified, and up-to-date.
• Oversee the maintenance and accuracy of the credentialing database, ensuring timely updates and compliance with data integrity standards.
• Conduct regular quality audits and ensure that credentialing documentation and processes adhere to internal and external guidelines.
• Lead internal QA initiatives and provide feedback on audit results to improve processes and prevent errors.

Required Qualifications

• 2+ years of experience in healthcare operations, credentialing, or provider coordination, preferably with knowledge of collaborative practice requirements.
• Familiarity with regulatory standards (state medical boards, CMS) related to NP/PA collaboration.
• 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.

Preferred Qualifications

• Experience with multi-state collaboration coordination.
• Understanding of payer compliance and credentialing timelines.
• Prior experience supporting provider relations or legal documentation workflows.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$17.00 - $28.46

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.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full?time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well?being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.