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Sr. Credentialing Specialist

San Antonio, CA · Healthcare
Sr. Credentialing Specialist
Full Time
Permanent Role

Sr. Credentialing Specialist
The purpose of the Air Force Centralized Credentials Verification Office CC(AFCCVO) is to provide a turn-key operation for credentialing support to the Air Force Medical Service (AFMS) by gathering required credentials, performing Primary Source Verification (PSV) of applicable credentials, conducting databank queries, and entering all data into the Centralized Credentials Quality Assurance System (CCQAS). The AFCCVO will also provide required data for future credentialing and privileging decisions to appropriate customers within the AFMS, Air Force Recruiting Services (AFRS), Air Force Personnel Center (AFPC), Air Reserve Personnel Center (ARPC), Air Force Reserve Command (AFRC) and Air National Guard (ANG) recruiters and units
AFCCVO will provide credentialing support to the AFMS by gathering required credentials, performing PSV of appropriate credentials and conducting databank queries, entering all data into CCQAS and providing required data for credentialing and privileging decisions to appropriate customers.
  • Five (5) years of experience in medical credentialing to include knowledge of the credentialing and privileging process, the required credentials for healthcare professionals, knowledge of appropriate sources used to complete PSV and databank queries.
  • Establish and manage a centralized Credentials Verification Office (CVO) in San Antonio, TX for the Clinical Quality Management Division, Air Force Medical Operations Agency (AFMOA/SGHQ).
  • Facilitate and support the Credentialing and Privileging (C&P) processes performed by Credentials Managers (CM) at approximately 76 active duty Military Treatment Facilities (MTFs) and approximately 144 noncollocated Air Reserve Components (ARC) across the Air Force (AF).
  • Facilitate and support the credentialing process for potential new accessions, deferred and non-deferred providers; providers enrolled in Air Force Institute of Technology (AFIT) training programs, healthcare students enrolled in military scholarship programs.
  • Collect the credentials outlined in AFI 44-119, process IAW AFI 44- 119 and AFMOA/SGHQ, and transmit to the end user the C&P information electronically and via hard copy (when required) for healthcare providers required to obtain a license, certification or registration.
  • Capture receipt date stamp on all credentialing documentation received.
  • Create or update the existing (if record has previously been established) electronic Provider Credentials Files (e-PCFs) in CCQAS.
  • Perform PSVs of required credentials (as established in AFI 44-119, Medical Quality Operations), and perform required databank queries for nonprivileged and privileged healthcare personnel.
  • Identify incomplete new accession applications and obtain the required information to complete the credentialing process.
  • Identify and elevate potential red flags identified during PSV and databank querying. Report red flag on new accession applicants to accession source (AFRS/ANG/HQ AF Reserve) and the Contracting Officer Representative (COR) for resolution.
  • Perform a one-time National Practitioner Data Bank (NPDB) query for Registered Nurses (RNs), Licensed Vocational Nurses (LVNs), and Licensed Practical Nurses (LPNs), if a previous query result is not on file in the e-PCF.
  • Scan as a Portable Document Format (PDF) file, appropriately name and upload credentials documentation, verifications and query results to the ePCFs in accordance with (IAW) the standard naming conventions provided by AFMOA/SGHQ.
  • Transmit credentialing summaries, e-PCFs, and other credentialing information and documentation to requestors as established by AFMOA/SGHQ.
  • Maintain the e-PCFs and if provided, the established 6-part Provider Credentials File (PCFs), on AF providers assigned to non-Military Treatment Facility (MTF) administrative positions, civilian medical treatment facilities or out-of-service training programs at non-Department of Defense (DoD) institutions. The contractor shall generate monthly expiration reports within CCQAS to track time limited credentials. The contractor shall obtain and upload updated credentials IAW AFI 44-119.
  • Respond within two (2) business days to telephone calls, faxes or email inquiries regarding the management or status of provider’s C&P information. These inquiries may be received from providers, CMs at MTF or medical units, AFRS, AFPC, HQ ANG/SG or HQ AF Reserve/SG offices, or AFMOA/SGHQ.
  • Complete PSVs and databank queries as required with appropriate updates to the e-PCF upon receipt of a CCQAS PSV task when an eApplication is routed to the CVO or upon receipt of the MTF or unit request form or when request query block is checked within CCQAS.
  • Track the status and report on physician licensure to ensure physician students have obtained an active unrestricted license by the end of Post Graduate Year 2 (PGY 2) (30 June of each year) IAW AFI 44-119. Reports will be made to AFPC and AFMOA/SGHQ by 1 September of each year.
  • Review e-PCFs maintained by the AFCCVO to ensure all credentials are updated, perform licensure PSV and a NPDB query not earlier than 30 days prior to forwarding e-PCF to MTF or medical unit.
  • Obtain the provider’s National Provider Identifier (NPI) number from the new accessions and providers in out-of-service training programs. Scan and upload documentation of the NPI to the e-PCF.
  • Enter the NPI number in the Defense Medical Human Resources System-Internet (DMHRSi) when the unit does not have access to DMHRSi and the NPI is not displayed in CCQAS.
  • Obtain access and then be trained to input provider NPIs into DMHRSi by the DMHRSi program office.
  • Conduct Department of Health and Human Services DHHS/TRICARE sanction checks for all newly hired providers. Uploads query results to the e-PCF.
Develop metrics to monitor turnaround times of the CVO processes for monthly reporting to Clinical Quality Management Division, AFMOA/SGHQ.
Metrics should include:
1) tracking the number of providers, by category, processed by the CVO per year,
2) turnaround time to monitor timelines in the process to include turnaround time from receipt of accession application and credentials information to the generation and transmission of the completed credentialing summary to the requestor, turnaround time for receiving a Complete PSV Task within CCQAS to returning the completed task to the requestor, turnaround time for completion of task received via MTF or medical unit paper request form for PSV/databank query to returning the completed task to the requestor
3) turnaround time from when C&P 7 documents are sent out to be completed by the practitioner and returned to the CVO
4) turnaround time to update the C&P information into CCQAS for the records being maintained by the AFCCVO
5) number of requests for information received by CVO
6) number NPI numbers entered into DMHRSi.
Maintain frequent contact with the COR to ascertain progress and problem areas that need to be resolved. The Chief, Professional Staff Management assigned to AFMOA/SGHQ (or designee) will be available as resources to assist the contractor with guidance and direction.

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