Supervisor, Credentialing Quality

Job not on LinkedIn

🔥 15 hours ago

🤠 Texas – Remote

🤠 Texas – Remote

💵 $43.9k - $85.1k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

✨ Supervisor

🚫👨‍🎓 No degree required

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Oversee the daily workflow of the Senior Audit Specialists to ensure timely and accurate completion of quality reviews for all credentialing and re-credentialing applications • Responsible for pulling and analyzing regular reports to monitor team performance and operational metrics • Ensure provider files strictly adhere to Federal, State, NCQA, and client policy requirements associated with delegated credentialing • Provide guidance, coaching, and regular performance feedback to the senior audit team • Train new Senior Specialists on the credentialing audit process, quality standards, error-reporting procedures, and NCQA guidelines • Analyze audit data to identify error trends, processing bottlenecks, and training opportunities • Serve as the final reviewer for complex credentialing audits, discrepancies, or appeals • Lead and assist with special projects to support quality operations and operational needs

🎯 Requirements

• 2 to 5 years leadership experience • 3 to 5 years of successful work experience, preferably in a credentialing/auditing role • 2 to 3 years’ experience stakeholder management • Must be familiar with NCQA accreditation standards • 3 to 5 years of experience using reporting tools including Excel and Power BI • Intermediate proficiency in G-Suite (Docs, Sheets, Slides, etc.) • Uncompromising attention to detail and accuracy, with an analytical mindset for spotting errors • Strict adherence to HIPAA regulations regarding Protected Health Information (PHI)

🏖️ Benefits

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs • comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families