At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.
As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.
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
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
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$18.50 - $35.29This 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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit https://jobs.cvshealth.com/us/en/benefits
We anticipate the application window for this opening will close on: 12/12/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.