Credentialing Specialist

About the role

Reviews analyzes, evaluates, validates provider/producer information against business/credentialing requirements and maintains information on Credentialing databases. Supports extensive research and analysis of sensitive provider/producer issues; addresses data integrity issues.

Responsibilities

• Aid in reviewing, analyzing, and validating provider/producer information to ensure it meets credentialing and business requirements
• Maintain and update provider/producer records in credentialing databases with a high level of accuracy
• Support research and review of provider/producer information, escalating sensitive or complex issues as needed
• Identify and correct data discrepancies to support overall data integrity and compliance
• Handle confidential and sensitive information with professionalism, discretion, and care
• Organize and prioritize assigned tasks to meet deadlines in a fast-paced environment
• Draft and respond to basic professional correspondence, including emails and routine notices
• Communicate effectively with providers, internal staff, and management under guidance and supervision
• Work independently on routine tasks while seeking guidance for new or complex issues
• Use Microsoft Office applications (Word, Excel, Access) and internet resources to research and maintain information
• Show strong attention to detail and willingness to learn credentialing policies, procedures, and systems

Requirements

• 1+ years customer service experience
• 6+ months experience researching and analyzing data
• 6+ months experience working with Microsoft Office applications (Word, Excel, Access) and internet resources
• Able to work Franklin Hybrid work model, 3 days in office

Preferred Qualifications

• Ability to work independently on routine tasks
• Able to work reliably, prudently, and tactfully with confidential information
• Able to organize and prioritize work and manage multiple priorities
• Excellent verbal and written communication skills including, letters, memos, and emails
• Able to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization

Education

• High School diploma preferred

Pay Range

The Typical Pay Range For This Role Is $17.00 - $28.46. 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.