Decypher · 1 day ago
Credentialing Specialist
San Antonio, TX
Full-time
Onsite
Mid Level
3+ years expDecypher is a company that partners with the Defense Health Agency to provide professional services and technology solutions in healthcare. The Credentialing Specialist supports senior credentialing specialists by performing primary source verification, reviewing credentialing applications, and maintaining accurate provider records to ensure compliance with government and DoD requirements.
Information Technology
No H1B
U.S. Citizen Only
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
Qualification
Required
High school diploma or equivalent
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
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
Communicates clearly, both orally and in writing in English
Company
Decypher
Decypher is an information technology company that provides IT management and consulting services.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
O
Orvis Meador
Chief Operating Officer
Company data provided by crunchbase