Supervisor, Credentialing Quality

Location: Texas

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

Requisition

Job Description The Credentialing Quality Supervisor oversees the day-to-day activities of the Senior Credentialing Specialists who are responsible for auditing the quality and accuracy of all applications reviewed by our credentialing team. You will play a critical role in maintaining our high standards by ensuring error-free processing and compliance. The Supervisor will maintain strong cross-departmental relationships with Credentialing Operations, Recruiting, and Compliance.

This role will report to our Operations Manager.

Diversity and Inclusion are core values at Signify Health and fostering a workplace culture reflective of that is critical to our continued success as an organization.

What will you do?

Oversee Quality Operations:
Manage the daily workflow of the Senior Audit Specialists to ensure timely and accurate completion of quality reviews for all credentialing and re-credentialing applications.

Reporting (KPIs and Metrics): candidate will be responsible for pulling and analyzing regular reports to monitor team performance and operational metrics. You will be expected to utilize specific internal systems to extract data, identify trends, and provide actionable insights to leadership. Ensure Compliance:
Oversee the audit process to ensure provider files strictly adhere to Federal, State, NCQA, and client policy requirements associated with delegated credentialing.

Team Leadership:
Provide guidance, coaching, and regular performance feedback to the senior audit team to align with individual, department, and company goals.

Training & Development:
Train new Senior Specialists on the credentialing audit process, quality standards, error-reporting procedures, and NCQA guidelines. Meets with Ops Mgr regularly to provide updates, reporting and feedback. Drive Continuous Improvement:
Analyze audit data to identify error trends, processing bottlenecks, and training opportunities for the broader credentialing team to improve overall quality.

Act as an Escalation Point:
Serve as the final reviewer for complex credentialing audits, discrepancies, or appeals regarding additional verifications (such as State Board Licenses and Department of Defense requests).Project Management:
Lead and assist with special projects to support quality operations and operational needs as directed by management.

Required Qualifications 2 to 5 years leadership experience3 to 5 years of successful work experience, preferably in a credentialing/auditing role2 to 3 years' experience stakeholder management. Demonstrates active listening skills and strong interpersonal skills, with the ability to build rapport and productive relationships with internal and external stakeholders

Must be familiar with NCQA accreditation standards.
3 to 5 years of experience using reporting tools including Excel and Power BITechnical

Skills:

Intermediate proficiency in G-Suite (Docs, Sheets, Slides, etc.).Attention to Detail:
Uncompromising attention to detail and accuracy, with an analytical mindset for spotting errors.

Compliance:
Strict adherence to HIPAA regulations regarding Protected Health Information (PHI).

Preferred Qualifications Previous experience in credentialing quality assurance, auditing, or as a Senior Credentialing Specialist, with a deep understanding of NCQA credentialing standards. Proven experience leading a team, with a focus on fostering a collaborative and productive work environment preferred.

Flexibility:
The ability to work overtime as needed to meet audit deadlines.

Education High school diploma or equivalent required

Preferred Education Associate's degree or equivalent combination of education and experience Anticipated Weekly Hours
40

Time Type Full time

Pay Range The typical pay range for this role is:$43,888.00 - $85,068.00

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…