Senior Credentialing Specialist

Credentialing Specialist

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: The Credentialing Specialist supports healthcare provider credentialing and privileging for DoD Military Treatment Facilities and Air Reserve Component medical units by reviewing applications, conducting primary source verifications, sanction and NPDB checks, and maintaining accurate provider records in CCQAS. The position ensures credentialing documentation and processes comply with applicable DHA, DoD, Air Force, and regulatory requirements while coordinating with healthcare organizations, licensing agencies, employers, and other stakeholders to obtain and verify credentials.

Required Qualifications:

• Education: Associates Degree
• Experience:
  • 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.
  • 3 years of credentialing experience with the DoD utilizing CCQAS.

U.S. Citizenship is required

Key Responsibilities:

• Designated by the lead senior credentialing specialist to manage specific processes with the C&P process.
• Designated DHA and AFMS agent to gather credentialing information, perform PSV of healthcare professionals' credentials, affiliation and work history verifications, sanction checks, and conduct databank queries. This supports the credentialing and privileging processes at DHA MTFs and ARC medical units.
• Completes written PSV documentation capturing the required components to document the PSV IAW DHA PM 6025.13, vol 4, directed by the COR and all regulatory guidelines.
• 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. Records must be current at all times.
• 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.
• Updates the appropriate screens within CCQAS to capture the credential and PSV of the credential.
• Converts documentation to a PDF format, scans, appropriately names and uploads the documentation to the provider's electronic credentials file.
• Completes credentialing tasks routed to the DHACCVO for action and appropriately updates the provider's electronic credentials file IAW DHA PM 6025.13, vol 4, and regulatory guidelines.
• 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 outlined in DHA PM 6025.13, vol 4, DAFI 44-119 and regulatory guidelines.
• 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 by the COR.
• 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: On site, at Decypher corporate office in San Antonio. 7:30 am to 4:30 pm, local San Antonio, TX time, Monday through Friday (excluding Federal Holidays).

Physical requirements: Work is primarily sedentary and performed in an office environment, requiring prolonged sitting, frequent computer use, and occasional standing, walking, bending, reaching, and lifting of office materials up to 20 pounds.

Compensation & Benefits: Up to $60,500 per year.

Decypher is an equal opportunity and affirmative action employer committed to a diverse and inclusive workforce (M/F/D/V)