Credentialing Specialist

Decypher•San Antonio, TX

5d•Onsite

About The Position

The Credentialing Specialist supports senior credentialing specialists by performing primary source verification, reviewing credentialing applications, maintaining accurate provider records, and ensuring compliance with government and Department of Defense requirements. The 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. The position is based on site in a modern office setting in San Antonio, Texas, and is scheduled Monday through Friday, 7:30 a.m. to 4:30 p.m. Pay is $26.77 per hour, plus $4.41 per hour for benefits.

Requirements

High school diploma or equivalent.
Three years of experience in medical credentialing.
One year of experience in the credentialing and privileging process.
One year of experience credentialing with the Department of Defense using CCQAS.
U.S. citizenship is required.
Ability to communicate clearly in English, orally and in writing.
Knowledge of government regulations, policies, procedures, and limitations within the scope of responsibilities.
Knowledge of standard software programs, including Microsoft Office Professional Suite.

Responsibilities

Perform credentialing tasks supporting processes managed by senior credentialing specialists and requests from Military Treatment Facilities (MTFs).
Conduct primary source verification of healthcare professionals’ credentials, affiliations, and work histories; perform sanction checks and conduct databank queries.
Review credentialing applications and follow up promptly to obtain missing credentials or information and complete verifications.
Create and maintain provider credentialing records in CCQAS.
Contact medical office staff, educational institutions, employers, licensing agencies, and certifying agencies to obtain and complete credential verifications.
Obtain required credentials and complete primary source verification with the originating source or designated agent; date-stamp documentation upon receipt.
Convert documentation to PDF, scan and appropriately name it, and upload it to providers’ electronic credential files and CCQAS as required.
Identify and report potential red flags to the requestor, submit required credential verification summaries, and complete verification tasks in CCQAS.
Audit provider credentialing applications and files for compliance with requirements.
Transfer provider credential files to the appropriate MTF credentialing office or training office.
Close out and inactivate electronic JCCQAS records when appropriate.
Respond to information queries and requests, resolve them when possible, or route them to the appropriate person.
Perform National Practitioner Data Bank queries for registered nurses, licensed vocational nurses, licensed practical nurses, and other non-privileged providers as directed.
Communicate clearly in English, orally and in writing, and coordinate with management levels as required by DoD policies or procedures.
Answer phone and email inquiries and direct requestors appropriately.
Apply knowledge of government regulations, policies, procedures, and limitations within the role’s scope of responsibilities.
Use standard software programs, including Microsoft Office Professional Suite.