Senior Credential Evaluator Jobs (NOW HIRING)

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Requisition Job Description

CVS Business Unit: Signify Health
Location / Logistics: This role is open to remote candidates, but preference is for candidates in Dallas, TX area that can work Hybrid every other Tuesday in office. (In office schedule is subject to change based on business needs.)
Our Dallas offices are located at: 4055 Valley View Ln #700, Dallas, TX 75244

Position Summary
The Senior Credentialing Specialist ensures all credentialing functions comply with internal policies, client contracts, URAC guidelines, NCQA standards, and all applicable state and federal requirements. This position provides guidance to staff and customers, helps manage workflow improvement projects, and handles non-routine business support tasks with limited supervision.

Key Responsibilities

• Serve as a subject matter expert on credentialing for internal staff and external customers.
• Prepare and provide education and training to Credentialing Specialists on credentialing policies and internal processes.
• Organize and conduct ongoing audits to evaluate compliance with standards, outcomes, and deliverable timelines.
• Review and process new clinician credentialing and re-credentialing files if required based on business needs.
• Perform primary source verifications by querying appropriate organizations (e.g., state boards, NPDB) and evaluating responses to ensure compliance.
• Assemble all verified information and prepare files for presentation to the Credentialing Committee.
• Maintain accurate copies of current state licenses, DEA certificates, malpractice coverage, and other required credentialing documents.
• Review all background checks, drug tests, and TB screenings and record the results.
• Utilize the MD Staff credentialing database to perform queries, generate reports, and optimize efficiency.
• Assist with the ongoing monitoring of contracted clinicians.
• Maintain responsibility for the security and privacy of any protected health information (PHI) accessed during work activities.
• Provide administrative support to department leadership and stakeholders.
• Actively demonstrate teamwork and assist with special projects.

Required Qualifications

• 3+ years of successful work experience, preferably in a credentialing role/department.
• Must be familiar with NCQA accreditation standards.
• Working knowledge of problem-solving and decision-making skills.
• Demonstrates active listening skills and strong interpersonal skills, with the ability to build rapport and productive relationships with internal and external stakeholders
• Strong organizational skills- attention to detail
• Intermediate skills with Google Suites

Preferred Qualifications

• NAMSS Certification as a Certified Provider Credentialing Specialist (CPCS), or ability to obtain within 2 years of eligibility.
• Demonstrated ability to organize and prioritize workload and day-to-day tasks

Education

• High school diploma or equivalent required

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

This 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.