Credentialing Specialist
Location: San Antonio, TX
Job Type: Professional Services
Company: Decypher
Category: Medical Services
Job Description Apply Now
About Decypher
Decypher is a distinguished provider of professional, technology, and management solutions and services, supporting an array of clients in the Federal, Commercial, Local, and State sectors. At Decypher, employees are highly valued and play a pivotal role in the ongoing success of both the organization and its clients. The company fosters a culture where talent and energy are respected, offering opportunities for meaningful career advancement. Decypher maintains a strong commitment to diversity and inclusion, and is proud to be an equal opportunity/affirmative action employer (M/F/D/V).
We are currently seeking a dedicated Credentialing Specialist to join our team and support our mission at Fort Sam Houston in San Antonio, Texas. This is a unique opportunity to be part of a dynamic professional environment where your expertise in medical credentialing will directly impact healthcare operations and patient care quality. If you are passionate about maintaining the highest standards in credentialing and privileging, we encourage you to apply by clicking the job application button.
Credentialing Specialist - SummaryThe Credentialing Specialist will be responsible for supporting the end-to-end credentialing processes for healthcare professionals within a complex medical environment. Working in collaboration with the senior credentialing team, you will ensure the accuracy and integrity of provider credentialing records and facilitate compliance with regulatory and organizational requirements. This position will leverage your experience in credentialing and knowledge of credentialing databases such as CCQAS, especially within Department of Defense (DoD) contexts.
Duties & Responsibilities- Perform credentialing tasks to support processes managed by the credentialing team and respond to Medical Treatment Facilities (MTFs) requests.
- Handle phone and email inquiries, directing requests for resolution as appropriate within the organization.
- Serve as the designated agent for gathering credentialing information, conducting primary source verification (PSV) of healthcare professionals’ credentials, and performing required databank queries.
- Review credentialing applications, follow up to obtain missing credentials or information, and ensure the creation and maintenance of accurate provider credentialing records within CCQAS.
- Contact medical office staff, educational institutions, licensing, and certifying agencies to obtain and verify required credentials.
- Obtain and complete PSV of credentials from the originating source or designated agent, documenting and date-stamping all received documentation.
- Identify and report potential red flags to the appropriate requestor, providing required credential verification summaries as needed.
- Transfer provider credential files to the appropriate MTF credentials office or training office, and close out or inactivate electronic CCQAS records as appropriate.
- Audit provider credentialing applications and files to ensure compliance with Defense Health Agency (DHA) guidelines and regulatory requirements.
- Perform National Practitioner Data Bank (NPDB) queries for Registered Nurses (RNs), Licensed Vocational Nurses (LVNs), Licensed Practical Nurses (LPNs), and any non-privileged providers as directed by the organization.
- Competitive compensation package aligned with industry standards.
- Comprehensive benefits package including medical, dental, and vision coverage.
- Opportunities for career advancement and professional development within a supportive team environment.
- Access to training and resources designed to foster continuous learning and skill enhancement.
- Inclusive workplace culture that values diversity and promotes work-life balance.
- Associate’s degree required.
- Minimum of five (5) years of experience in medical credentialing, including expertise in the credentialing and privileging process, familiarity with required credentials for healthcare professionals, and knowledge of appropriate sources for PSV, work history verifications, sanction checks, and databank queries.
- At least three (3) years of credentialing experience using the Centralized Credentials Quality Assurance System (CCQAS) within Department of Defense environments.
- U.S. citizenship required.
- Active favorable National Agency Check with Inquiries (NACI) prior to hiring.
- Demonstrates meticulous attention to detail and a commitment to maintaining accuracy in all credentialing documentation and processes.
- Possesses strong interpersonal skills for effective communication with internal teams, healthcare professionals, and external agencies.
- Exhibits proficiency with credentialing databases, especially CCQAS, and is adept at managing complex credentialing workflows.
- Demonstrates sound judgment in identifying and reporting discrepancies or red flags during the credentialing process.
- Thrives in a fast-paced environment, managing multiple priorities while adhering to established deadlines and compliance requirements.
- The Credentialing Specialist role is integral to ensuring compliance with healthcare regulations and maintaining high standards of care within the organization.
- Decypher is dedicated to providing a collaborative and supportive work environment where employees are encouraged to grow professionally and contribute to the company’s mission.
- Working in San Antonio, Texas, offers the opportunity to be part of a vibrant and diverse community with a strong healthcare sector.
- Decypher is an equal opportunity/affirmative action employer committed to diversifying its workforce (M/F/D/V).
If you are ready to take the next step in your credentialing career and make a meaningful impact within a respected organization, we invite you to apply for the Credentialing Specialist position by clicking the job application button today.