Credentialing Specialist
Location: San Antonio, TX
Company: Decypher
Job Description Apply Now
Join Decypher and make a direct impact on the health and readiness of America’s service members, veterans, and their families. Since 2008 Decypher has offered healthcare industry professionals careers where their expertise is valued, and their work makes a meaningful impact. Decypher partners with the Defense Health Agency to deliver professional services, technology, and management solutions. Our mission is to provide and support quality care for our veterans, servicemembers and their families, across the United States.
Job Summary: Supports senior credentialing specialists by performing primary source verification (PSV), reviewing credentialing applications, maintaining accurate provider records, and ensuring compliance with government and DoD requirements. This role coordinates with medical offices, licensing agencies, and internal stakeholders to verify credentials, identify potential issues, manage electronic credentialing systems, and respond to credentialing inquiries in a timely and professional manner.
Required Qualifications:
- Education: High school diploma or equivalent
- Experience:
- 3 years of experience in medical credentialing
- 1 year of experience in credentialing and privileging process
- 1 year of experience credentialing with DoD utilizing CCQ
U.S. Citizenship is required
Key Responsibilities:
- Performs credentialing tasks in support of the processes managed by the senior credentialing specialists and in response to MTFs requests.
- Performs PSV of healthcare professionals’ credentials, affiliation and work history verifications, sanction checks, and conduct databank queries.
- Reviews credentialing applications, conduct follow-up in a timely manner to obtain missing
- credentials/information, conduct verifications, create provider credentialing records within CCQAS and maintain the CCQAS records.
- Contacts medical office staff, educational institutions, employers, licensing and certifying
- agencies, to obtain and complete the verification of credentials.
- Obtains required credentials and complete PSV of the credentials from the originating source or designated agent, date stamps the documentation upon receipt.
- Converts documentation to a PDF format, scans, appropriately names and uploads then documentation to the provider’s electronic credentials file.
- Identifies and reports potential “red flags” to the requestor and submits required credentials verification summaries, completes verification tasks within CCQAS and scans, appropriately names and uploads required documentation to CCQAS.
- Audits provider credentials application and credentials file for compliance with requirements
- Transfers provider credentials files to MTF credentials office or training office as appropriate.
- Closes out and inactivates electronic JCCQAS records when appropriate.
- Responds to queries/request for information and resolves originating request or routes the request to the appropriate individual for resolution.
- Perform National Practitioner Data Bank (NPDB) query for Registered Nurses (RNs), Licensed Vocational Nurses (LVNs), and Licensed Practical Nurses (LPNs) and any non-privileged provider as directed.
- Communicates clearly, both orally and in writing in English.
- Coordinate with the management levels, as required by DoD policies or procedures.
- Answer phone and email inquiries and direct requestor appropriately for resolution.
- Knowledge of government regulations, policies, procedures, and limitations within their scope of responsibilities.
- Knowledge of standard software programs such as the Microsoft Office Professional Suite.
Work Environment & Schedule: Monday to Friday, 7:30am to 4:30pm on site in office setting.
Decypher is an equal opportunity and affirmative action employer committed to a diverse and inclusive workforce (M/F/D/V)