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.
Position Introduction and Overview:
This role will report to our Provider Enrollment Supervisor
Responsible for reviewing and processing credentialing applications and supporting documentation for the purpose of enrolling individual physicians and physician groups in Medicaid and Medicare. Responsible for accurate and timely processing of Part B provider enrollment applications.
Roles & Responsibilities:
- Ability to work within a deadline-intense environment.
- Interact professionally with providers and staff representatives to provide information on any necessary documentation required for processing.
- Plan, prioritize, organize and complete work to meet established objectives.
- Track and follow up with providers for timely return of all required documents and applications.
- Assists in synchronization of data among multiple systems
- Validates the data to be housed on provider databases and ensuring adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing
- Display in-depth knowledge of and execute all standard operating procedures (SOPs) as well as communicating issues, trends, concerns and suggestions to leadership.
- In-depth working knowledge of the various payer applications associated and the workflow process.
- Ensure all workflow items are completed within the set turn-around-time, meeting quality expectations.
Basic Qualifications:
- Knowledge of health plan and governmental payer credentialing, enrollment and requirements acquired through completion of a CPCS certification course, or sufficient job-related experience with intent to pursue certification.
- Knowledge of PECOS and State Medicaid Enrollment applications
Preferred Qualifications:
- Experience with MD Staff credentialing and enrollment software preferred
- Knowledge of standards interpretation as related to NCQA
- 3 years of experience in a centralized credentialing office and direct provider enrollment experience, such as credentialing or file maintenance, preferred with experience in Word and Excel
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$17.00 - $28.46This 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.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
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.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
