Senior Credentialing Specialist
Location: San Antonio, TX
Company: Decypher
Job Description Apply Now
About Decypher
Decypher is a leading integrator of professional, technology, and management solutions and services. We provide our services globally to Federal, Commercial, Local and State clients. Our employees are our most valuable asset and play an integral role in the success of Decypher and our clients. Working at Decypher is not a job, but a career where your talent and energy is respected, and you can personally make a difference. Decypher invites you to join our professional team. Decypher is an equal opportunity/affirmative action employer committed to diversifying its workforce (M/F/D/V).
DESCRIPTION
Decypher is seeking an experienced Senior Credentialing Specialist to support the mission for Fort Sam Houston in San Antonio, TX. (Onsite/Hybrid position)
QUALIFICATIONS
- Education: Associates degree
- Work Experience: Five (5) years of experience in medical credentialing to include knowledge of the credentialing and privileging process, the required credentials for healthcare professionals, knowledge of appropriate sources used to complete PSV, work history verifications, sanction checks, and databank queries. Three (3) years of credentialing experience with the DoD utilizing CCQAS.
- Additional: US Citizen, shall have an active favorable NACI prior to hiring.
RESPONSIBILITIES
- Performs credentialing tasks in support of the processes managed by the senior credentialing specialists and in response to MTFs requests.
- Answer phone and email inquiries and direct requestor appropriately for resolution.
- Designated AFMS agent to gather credentialing information, perform PSV of healthcare professionals’ credentials and conduct databank queries.
- Reviews credentialing applications, conduct follow-up to obtain missing credentials/information, conduct verifications, create provider credentialing records within CCQAS and maintain the CCQAS record.
- Contacts medical office staff, educational institutions, 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.
- Identifies and reports potential “red flags” to the requestor and submits required credentials verification summaries.
- Transfers provider credentials files to MTF credentials office or training office as appropriate. Closes out and inactivates electronic CCQAS records when appropriate.
- 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 record. - Audits provider credentials application and credentials file for compliance with requirements outlined per DHA guidelines.
- 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.