Credentialing Specialist (Fully Remote)
CVS Pharmacy - Baton Rouge, LA
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Job DescriptionWe are currently recruiting top talent for a fast-paced opportunity in our Medicaid Credentialing organization.The Medicaid Credentialing Analyst is/will:- Manage provider requests for participation- Assess Credentialing Management Data (BusinessReview, Initial / Re-credentialing /Off-cycle and ongoinglicense/sanction monitoring) for all network and nonnetworkproviders- Ensure all provider information is verified and accuratelyrecorded/maintained facilitating member access,protection against substandard care and minimizingcorporate risk- Audits timeliness and maintains resource material and/orlibrary of available resources such as standard operatingprocedures, contractual references, state licensesources, etc.- Provides telephonic education to providers/producers oncredentialing policies and procedures- Directly contacts providers/producers and/or outsideentities to clarify data quality issues- Completes all credentialing requirement documents;identified by contract requirements; managed bycompliance- Coordinates receipt of provider/producer data withoutside vendors and other entities- Participate in team projects to standardize and optimizeprocesses- Acts as credentialing subject matter expert- Acts as health plan support and liaison by conductingtraining, addressing issues, monitoring performance, andensuring state contractual requirements are met- Works collaboratively with network staff (local andregional) in issue/problem identification and resolution- Maintains high production and quality factorsRequired Qualifications- Must be willing to support EDT/CDT time zones.- 1-3 years of Credentialing experience or experience in aproduction environment.- Possesses a basic knowledge of credentialing accreditingagencies and their standards and guidelines- Proven critical thinking and problem resolution skills- Strong organizational skills and detail-oriented. - Strong multi-tasking skills.COVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications- Experience and/or knowledge of Credential VerificationOrganization (CVO)- Experience and/or knowledge of Medicaid- Insurance knowledge background with Commercial Medicaid or Medicare.Education- High School Diploma or G.E.D.- College degree preferred not required or equivalent work experience preferred.Business OverviewBring your heart to CVS HealthEvery 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.
Created: 2024-09-07