Senior Credentialing Specialist

Decypher • San Antonio, TX

43d

About The Position

Decypher is seeking an experienced Senior Credentialing Specialist in San Antonio, TX.

Requirements

• Associates degree
• 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.
• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Industry: Educational Services
• Education Level: Associate degree
• Number of Employees: 101-250 employees