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 Summary
The Credentialing Coordinator manages the initial credentialing and re-credentialing process for nurse practitioners, physician assistants, behavioral health providers, and physicians. This role helps ensure credentialing activities are completed accurately, on time, and in compliance with Joint Commission, NCQA, and URAC standards. The coordinator also monitors expirable credentials, supports compliance oversight, and maintains accurate provider documentation.
Key Responsibilities
Process initial and re-credentialing applications for NP, PA, behavioral health, and physician providers in accordance with MinuteClinic credentialing policies and program requirements.
Track expired licensure reports, database tasks, system updates, and weekly leadership reporting.
Manage Epic access for providers with noncompliant licensure or board certification status.
Perform sanctions and compliance monitoring and escalate undisclosed negative findings to the Credentialing Manager and Revenue Director.
Complete malpractice insurance verification requests according to internal guidelines.
Maintain provider and physician SharePoint sites and communicate provider status updates to leadership and internal teams to support timeline adherence.
Submit system access requests after credentialing approval and clinic eligibility confirmation.
Assist the payer enrollment team with resolving payer claim issues as needed.
Review provider and clinic change or termination reports and update the database as appropriate.
Process provider name changes in accordance with MinuteClinic policies and procedures.
Maintain provider credentialing grids and notify appropriate teams of updates.
Review and distribute incoming mail as needed.
Support payer audits in alignment with MinuteClinic, Joint Commission, and NCQA requirements.
Ensure provider files contain current and complete information and documentation.
Inform system analysts and leadership of system interruptions, state agency updates, and password changes.
Identify opportunities to improve processes and increase system efficiencies.
Participate actively in team meetings.
Promote a positive team environment and work effectively in a fast-paced setting.
Demonstrate understanding of initial credentialing and re-credentialing practices for medical professionals including primary source verification methods, compliance monitoring and expirable management.
Required Qualifications
Minimum of three years of healthcare industry experience, including credentialing experience.
Proficient in quantitative data analysis
Understanding of Joint Commission Accreditation, NCQA and URAC credentialing standards.Ability to function independently and utilize critical thinking skills to accomplish goals and objectives
Meticulous attention to detail
Effective communication skills; verbal and written
Strong interpersonal skills including the ability to work well with internal and external stakeholders
Strong organizational skills and the ability to multitask
Competent user of Microsoft Office, Outlook, Word, and Excel
Preferred Qualifications
- Certified Billing and Coding Specialist (CBCS)
- NAMSS Certified Professional Credentialing Specialist (CPCS) certification.
- Associates or bachelor’s in business highly preferred
- MDStaff experience preferred
Education
• Verifiable High School Diploma is required.
• Associate or bachelor’s degree, highly preferred.
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$18.50 - $38.82This 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.
Skills Required
- Minimum of three years healthcare industry experience including credentialing experience
- Proficient in quantitative data analysis
- Understanding of Joint Commission, NCQA, and URAC credentialing standards
- Ability to function independently and use critical thinking
- Meticulous attention to detail
- Effective verbal and written communication skills
- Strong interpersonal skills to work with internal and external stakeholders
- Strong organizational skills and ability to multitask
- Competent user of Microsoft Office, Outlook, Word, and Excel
- Verifiable High School Diploma (required)
- Certified Billing and Coding Specialist (CBCS)
- NAMSS Certified Professional Credentialing Specialist (CPCS)
- Associate's or Bachelor's degree in business (highly preferred)
- MDStaff experience
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.
