CVS Health / Oak Street Health is hiring a Sr. Credentialing Specialist

At CVS Health, we're crafting a comprehensive health ecosystem centered around every individual, surrounded by committed professionals passionate about revolutionizing healthcare delivery. As the premier health solutions enterprise, we engage millions of Americans through our local footprint, digital platforms, and over 300,000 mission-driven team members – delivering personalized care that is more interconnected, accessible, and empathetic, consistently executing our mission with genuine dedication. Position Introduction and Overview: The Senior Credentialing Specialist is tasked with guaranteeing that Signify Health's network providers meticulously comply with all requisite business, regulatory, and accreditation requirements. This role demands a comprehensive approach, involving meticulous examination, verification, and sophisticated investigative analysis of confidential provider data to directly enhance data precision and regulatory adherence. Beyond fundamental credentialing responsibilities, the Specialist drives procedural optimization, manages provider and committee inquiries, executes critical administrative support functions, and conducts continuous quality assessments and educational initiatives to reinforce standards and inform stakeholders. The primary objectives are ensuring robust compliance and effective information management, facilitating seamless team collaboration to rapidly resolve challenges and proactively prevent potential service interruptions. Roles & Responsibilities: - Compliance and Validation: Comprehensively evaluate and authenticate all provider information to guarantee strict alignment with internal protocols, state regulations, and accreditation standards. - Investigative Review and Analysis: Execute comprehensive research and sophisticated analysis on sensitive provider matters. Proactively address data integrity concerns by preparing and rigorously reviewing investigative documentation, including complex, high-risk credentialing verifications. - Process Improvement: Proactively identify, propose, and implement strategic enhancements to continuously refine credentialing workflows and operational procedures. - Inquiry Management and Support: Serve as primary point of contact for providers and committee members, expertly managing their inquiries and resolving credentialing and data management challenges. Administrative and Operational Support: - Execute routine and specialized business support tasks with minimal supervision, adhering to established protocols and escalating deviations to management. - Provide crucial administrative assistance to the Credentialing Committee Liaison, managing application assignments, distributing official correspondence, and publishing appointments. - Maintain systematic data collection, tracking, and reporting mechanisms. Auditing and Training: - Conduct comprehensive ongoing audits to rigorously assess compliance with standards, expected outcomes, and deliverable timelines. - Develop and deliver impactful educational content on credentialing policies and procedures for internal teams and healthcare providers. - Cultivate robust collaborative relationships to discuss credentialing requirements, swiftly resolve issues, and prevent service disruptions. Basic Qualifications: - 2+ years healthcare operations or credentialing experience, preferably with application processing expertise - Proficiency with Credentialing Database Systems, particularly MD Staff - Exceptional organizational skills with meticulous attention to detail - Technical proficiency in MD-Staff, Google Suite, PowerBi, Microsoft Office Suite - Superior verbal and written communication capabilities - Ability to manage multiple priorities independently in dynamic environments Preferred Qualifications: - Adaptability to evolving regulatory landscapes with minimal supervision - Exceptional precision and conscientiousness regarding compliance - Comprehensive proficiency processing credentialing applications across all complexity levels Anticipated Weekly Hours: 40 Time Type: Full time Pay Range: $18.50 - $35.29 Our organizational culture celebrates diversity, reflecting the communities we serve, committed to creating an inclusive environment where every team member feels valued and empowered. Comprehensive Benefits: - Competitive compensation with medical plan options, 401(k) matching, employee stock purchase program - Complimentary wellness initiatives including screenings, health management programs - Flexible benefit solutions addressing diverse colleague needs: paid time off, flexible scheduling, family support resources Application Window Closes: 12/14/2025 Qualified candidates with arrest or conviction records will be considered consistent with applicable legal guidelines.