Credentialing Specialist - Hybrid/Remote, Health Compliance

QuickCruit, Inc.; Dallas (TX); Hybrid; USD 23,000 - 39,000; Full time

Job summary

CVS Health in Dallas, TX is seeking a Credentialing Specialist to support clinicians through the Signify Health credentialing process and related documentation.

You will assist with credentialing applications, perform primary source verifications, and maintain the MD Staff credentialing database, ensuring adherence to NCQA and URAC guidelines and applicable state/federal requirements.

Qualifications

• Review and process credentialing and re-credentialing files.
• Establish and maintain a system for timely processing of credentialing files in line with NCQA policies.
• Query appropriate organizations and evaluate responses for provider NCQA compliance.
• Maintain copies of licenses, DEA certificates, malpractice coverage and other credentialing documents.
• Review background checks, drug tests, and TB screenings and record results.

Responsibilities

• Review and process credentialing and re-credentialing files.
• Establish and maintain a system for timely processing of credentialing files in line with NCQA policies.
• Query appropriate organizations and evaluate responses for provider NCQA compliance.
• Maintain copies of licenses, DEA certificates, malpractice coverage and other credentialing documents.
• Review background checks, drug tests, and TB screenings and record the results.
• Assemble verified information and prepare files for Credentialing Committee.
• Verify providers’ requirements for approval to work in specific states and plans.
• Assist with ongoing monitoring of contracted clinicians.
• Use the credentialing database to perform queries, generate reports, and optimize efficiency.

Job description

CVS Health in Dallas, TX is seeking a Credentialing Specialist to support clinicians through the Signify Health credentialing process and related documentation.

You will assist with credentialing applications, perform primary source verifications, and maintain the MD Staff credentialing database, ensuring adherence to NCQA and URAC guidelines and applicable state/federal requirements.