Credentialing Specialist

About This Role

Supporting senior credentialing specialists, this role performs primary source verification, reviews applications, and maintains accurate provider records. The specialist ensures compliance with government and DoD requirements, coordinating with various agencies and stakeholders to verify credentials and manage electronic systems.

Responsibilities

• Perform credentialing tasks in support of processes managed by senior credentialing specialists and in response to MTFs requests
• Perform PSV of healthcare professionals’ credentials, affiliation and work history verifications, sanction checks, and conduct databank queries
• Review 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
• Contact medical office staff, educational institutions, employers, licensing and certifying agencies, to obtain and complete the verification of credentials
• Obtain required credentials and complete PSV of the credentials from the originating source or designated agent, date stamps the documentation upon receipt
• Convert documentation to a PDF format, scan, appropriately name and upload the documentation to the provider’s electronic credentials file
• Identify and report potential “red flags” to the requestor and submit required credentials verification summaries, complete verification tasks within CCQAS and scan, appropriately name and upload required documentation to CCQAS
• Audit provider credentials application and credentials file for compliance with requirements
• Transfer provider credentials files to MTF credentials office or training office as appropriate
• Close out and inactivate electronic JCCQAS records when appropriate
• Respond to queries/request for information and resolve originating request or route 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
• Communicate 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

Requirements

• High school diploma or equivalent
• 3 years of experience in medical credentialing
• 1 year of experience in credentialing and privileging process
• 1 year of experience credentialing with DoD utilizing CCQAS
• U.S. Citizenship is required
• Knowledge of government regulations, policies, procedures, and limitations within their scope of responsibilities