Credentialing Specialist
Location: San Antonio, TX
Job Type: Federal
Company: Decypher
Category: Medical Services
Job Description Apply Now
Are you looking to advance your career in healthcare administration and compliance? Decypher is seeking a dedicated Credentialing Specialist to join our team and help shape the readiness and well-being of America's service members, veterans, and their families. As a Credentialing Specialist at Decypher, you will play a vital role in supporting national health initiatives in partnership with the Defense Health Agency. This full-time opportunity offers the chance to be part of a mission-driven organization that values expertise, professionalism, and a commitment to quality care.
Decypher has been at the forefront of delivering healthcare professional services, technology, and management solutions since 2008. Our work is rooted in the mission to provide and support exceptional care for military communities across the United States. As a Credentialing Specialist, you will help ensure that only qualified healthcare professionals serve our nation's heroes, working alongside senior credentialing staff and a collaborative team in a fast-paced, detail-oriented environment.
This position is a full-time role based in a professional office setting. You will collaborate with medical offices, licensing agencies, and internal stakeholders to perform primary source verifications, oversee electronic credentialing systems, and manage credentialing inquiries. Your attention to detail and organizational skills will contribute directly to the effectiveness of our credentialing processes and compliance with Department of Defense (DoD) requirements. Working with Decypher in this capacity offers the unique opportunity to impact both the lives of healthcare providers and the quality of care delivered to service members and their families.
Credentialing Specialist - Summary- Facilitate the credentialing process for healthcare professionals in alignment with government and DoD guidelines
- Collaborate with internal and external partners to ensure accurate and timely verification and maintenance of provider credentials
- Support the mission of providing quality healthcare services to service members, veterans, and their families
- Support senior credentialing specialists by performing primary source verifications (PSV) of healthcare provider credentials
- Review credentialing applications, follow up promptly to acquire missing documentation, and maintain complete provider records
- Coordinate with medical office staff, educational institutions, employers, and licensing agencies to obtain verification of credentials
- Manage electronic credentialing systems, including creating and maintaining provider records in CCQAS
- Identify, document, and report potential red flags, and prepare credentials verification summaries
- Audit provider credentials applications and files for compliance with applicable requirements
- Transfer and close out provider credentials files as required, including managing JCCQAS records
- Respond to credentialing inquiries and route requests appropriately for resolution
- Perform National Practitioner Data Bank (NPDB) queries for various types of nursing and non-privileged providers as directed
- Communicate effectively in English, both orally and in writing
- Apply knowledge of government regulations, DoD policies, and industry-standard software in daily tasks
- Competitive compensation package commensurate with experience and responsibilities
- Comprehensive benefits available to full-time employees (details provided during the interview process)
- Opportunities for career advancement and professional development within a respected healthcare solutions provider
- Supportive and inclusive organizational culture
- High school diploma or equivalent required
- Minimum of three (3) years experience in medical credentialing
- At least one (1) year of experience in the credentialing and privileging process
- One (1) year experience credentialing with the Department of Defense (DoD) utilizing CCQ
- U.S. citizenship is required
- Strong organizational skills and meticulous attention to detail
- Proficiency in Microsoft Office Professional Suite and familiarity with electronic credentialing systems
- Demonstrates reliability, professionalism, and a commitment to compliance
- Possesses excellent communication skills and the ability to interact with a diverse range of stakeholders
- Thrives in a fast-paced, team-oriented environment and is able to manage multiple priorities
- Has a strong sense of responsibility for ensuring the accuracy and security of sensitive credentialing information
- Adapts quickly to new processes, regulations, and technology platforms
- Full-time, on-site position in a professional office environment
- Standard work schedule is Monday to Friday, 7:30am to 4:30pm
- Work as part of a team committed to supporting military and veteran healthcare initiatives
- Decypher is an equal opportunity and affirmative action employer committed to a diverse and inclusive workforce (M/F/D/V)
If you are ready to make a meaningful impact as a Credentialing Specialist with Decypher, click the job application button now to join our mission-driven team and help advance the quality of care for those who serve and protect our nation.