Credentialing Specialist
Location: San Antonio, TX
Job Type: Federal
Company: Decypher
Category: Medical Services
Job Description Apply Now
Decypher is seeking a dedicated Credentialing Specialist to join our team and play a pivotal role in supporting the health and readiness of America's service members, veterans, and their families. As a trusted partner to the Defense Health Agency, Decypher delivers comprehensive professional services, technology, and management solutions tailored to the needs of military healthcare. The Credentialing Specialist position is central to ensuring that healthcare providers meet all regulatory and professional standards, maintaining the highest level of care for those who serve.
As a Credentialing Specialist, you will be responsible for managing healthcare provider credentialing and privileging processes. This includes reviewing applications, performing primary source verifications, conducting sanction and National Practitioner Data Bank (NPDB) checks, and maintaining meticulous provider records within the Credentials and Privileging system (CCQAS). You will ensure that all credentialing documentation and processes align with Defense Health Agency, Department of Defense, Air Force, and additional regulatory requirements. Your expertise will be crucial in facilitating communication and coordination with healthcare organizations, licensing agencies, employers, and other key stakeholders to verify credentials efficiently and accurately.
Decypher fosters a mission-driven environment where your skills and attention to detail will directly impact the quality of care delivered to our military community. Working at Decypher offers the opportunity to collaborate with dedicated professionals and contribute to the support structure that upholds medical readiness across the United States. The company values diverse talents and perspectives, cultivating a workplace where inclusivity and professional growth are priorities.
Located in San Antonio, the Credentialing Specialist will benefit from a vibrant professional setting in a city known for its rich culture and commitment to supporting military personnel. You will be part of a collaborative team, working in a modern office environment designed to encourage productivity and well-being.
If you are detail-oriented, committed to compliance, and passionate about supporting the healthcare needs of military families, we encourage you to apply for this full-time Credentialing Specialist position by clicking the job application button below.
Credentialing Specialist - Summary- Facilitates the complete credentialing and privileging process for healthcare providers in compliance with Defense Health Agency and Department of Defense regulations.
- Ensures accurate and timely verification of provider credentials using primary sources and maintains up-to-date records within CCQAS.
- Coordinates with external agencies, employers, and educational institutions to gather and verify essential documentation.
- Supports the mission to deliver quality healthcare to service members, veterans, and their families through diligent credentialing practices.
- Manage and oversee specific credentialing and privileging processes as designated by the lead credentialing specialist.
- Gather credentialing information and perform primary source verifications for healthcare professionals.
- Conduct work history verifications, sanction checks, and databank queries such as NPDB for various provider types.
- Perform written documentation of all primary source verifications in accordance with DHA PM 6025.13, vol 4, and regulatory guidelines.
- Review credentialing applications, follow up to obtain missing information, and create and update provider records in CCQAS.
- Contact and coordinate with medical office staff, licensing and certifying agencies, and employers to complete credential verifications.
- Convert, scan, and upload documentation into electronic credential files, ensuring accurate and current records.
- Identify and report potential red flags and submit credentials verification summaries as required.
- Audit provider credentials and application files to maintain compliance with all applicable regulations.
- Transfer and inactivate provider credential files as necessary and respond to information requests in a timely manner.
- Utilize standard office software tools such as Microsoft Office Suite to complete daily tasks.
- Communicate effectively in English, both verbally and in writing, to support credentialing activities and resolve inquiries.
- Competitive annual compensation up to $60,500.
- Access to a comprehensive benefits package, supporting your health, well-being, and professional growth.
- Opportunities for career advancement and ongoing professional development within a mission-driven organization.
- Associate's degree required.
- Minimum five (5) years of experience in medical credentialing, including familiarity with credentialing and privileging processes, primary source verification, and compliance with regulatory standards.
- At least three (3) years of experience in Department of Defense credentialing utilizing CCQAS.
- Extensive knowledge of relevant government regulations, policies, and procedures pertaining to healthcare credentialing.
- Strong computer proficiency with Microsoft Office Suite and electronic records management.
- Must possess U.S. citizenship.
- Excellent organizational, communication, and analytical skills.
- Meticulous attention to detail and a commitment to maintaining the highest standards of compliance and accuracy.
- Proven experience working with complex credentialing systems and regulatory frameworks.
- Ability to communicate clearly and professionally with stakeholders at all levels.
- Strong problem-solving abilities and a proactive approach to identifying and resolving credentialing issues.
- Demonstrated dedication to supporting the healthcare needs of military personnel and their families.
- Full-time position based at Decypher's corporate office.
- Standard office hours with no requirement for weekend or holiday shifts.
- Work is primarily sedentary, performed in an office environment with prolonged computer use and occasional lifting of up to 20 pounds.
- 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 contribute your expertise as a Credentialing Specialist and be part of a team that impacts the healthcare of service members and their families, apply now by clicking the application button below.