Credentialing Specialist

About Decypher Decypher is a leading integrator of professional, technology, and management solutions and services. We provide our services globally to Federal, Commercial, Local and State clients. Our employees are our most valuable asset and play an integral role in the success of Decypher and our clients. Working at Decypher is not a job, but a career where your talent and energy is respected, and you can personally make a difference. Decypher invites you to join our professional team. Decypher is an equal opportunity/affirmative action employer committed to diversifying its workforce (M/F/D/V). Description Decypher is seeking an experienced Credentialing Specialist to support the mission for Fort Sam Houston in San Antonio, TX. Qualifications Three (3) years of experience in medical credentialing to include one (1) year of knowledge of the credentialing and privileging process, the required credentials for health care professionals, and the appropriate sources used to complete PSV, work history verifications, sanction checks, and databank queries. One (1) year of credentialing experience with the DoD utilizing CCQAS. US Citizen NACI background check Responsibilities Performs credentialing tasks in support of the processes managed by the senior credentialing specialists and in response to MTFs requests. Performs PSV of healthcare professionals’ credentials, affiliation and work history verifications, sanction checks, and conduct databank queries. 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 records. Contacts medical office staff, educational institutions, employers, 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. Converts documentation to a PDF format, scans, appropriately names and uploads then documentation to the provider’s electronic credentials file. Identifies and reports potential “red flags” to the requestor and submits required credentials verification summaries, completes verification tasks within CCQAS and scans, appropriately names and uploads required documentation to CCQAS. Audits provider credentials application and credentials file for compliance with requirements Transfers provider credentials files to MTF credentials office or training office as appropriate. Closes out and inactivates electronic CCQAS records when appropriate. Responds to queries/request for information and resolves originating request or routes the request to the appropriate individual for resolution. 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. Communicates clearly, both orally and in writing in English. Coordinate with the management levels, as required by DoD policies or procedures. Answer phone and email inquiries and direct requestor appropriately for resolution. Knowledge of government regulations, policies, procedures, and limitations within their scope of responsibilities. Knowledge of standard software programs such as the Microsoft Office Professional Suite. This job description is not intended to be all inclusive. Therefore, the employee may be requested to perform other reasonable duties as assigned by the immediate supervisor or other management as required. This position is not authorized for remote/telework. #J-18808-Ljbffr