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.
Position Summary
– Maintains high production and quality factors.
– Participates in development of credentialing processes and workflows.
– Identifies improvement opportunities and recommends enhancements and workable solutions.
– Provides telephonic education to providers/producers on credentialing policies and procedures.
– Identifies and communicates trends (quality of results, efficiencies of processes).
– Researches and prepares risk sensitive or complex business review/credentialing verification items for CPC.
– Reviews completed investigative files of co-workers for completion and accuracy. Manages vendor online access of primary verification sources. Provides ongoing support to department members in completing research and analysis to resolve complex issues raised by providers/producers and other internal/external customers.
– Directly contacts providers/producers and/or outside entities to clarify data quality issues.
– Provides issue resolution for providers/producers, during the credentialing or data management processes.
– Responds to network or provider/producer inquiries, including contracting and credentialing policy, procedures, credentialing status.
– Perform data entry and systems maintenance as needed; align data across systems.
– Ongoing License Sanction monitoring and reporting to minimize corporate risk.
Required Qualifications
– 1+ years of Credentialing experience
-1+ years of Provider Data Service experience
Demonstrated track record of prioritizing work, multi-tasking, and managing workload efficiently.
– 1 +years of Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel
Preferred Qualifications
– QNXT experience
– Ability to consistently meet and/or exceed performance/production goals
Education– High School Degree or G.E.D.
Pay Range
The typical pay range for this role is:
$17.00 – $28.45