Essential Duties & Responsibilities

The Credentialing Coordinator is responsible for assigned tasks such as, but not limited to the following:

• Process provider initial and reappointment applications; monitor and follow-up as needed to ensure timely appointments and privileges.
• Verification of provider credentials and the facilitation of initial appointment and reappointment.
• Ensure accurate and timely submission of credentialing and recredentialing applications for both organizations and individual providers; monitor and follow-up as needed to ensure credentialing compliance.
• Coordinate and assist in the enrollment, re-enrollment, revalidation, and submission of data/documents for providers and organizations so that they may submit claims for payment.
• Track and monitor documents of current state licenses, Drug Enforcement Agency certifications, malpractice coverage, specialty certifications, health records and other required credentialing documents to ensure the timely renewals for all providers and regulatory compliance.
• Maintain multiple Provider Credentialing Databases.
• Communicate with payers, providers, leadership, and other entities to support activities with regards to real-time information, schedules, provider requests and meetings.
• Assist in compliance with the accrediting and regulatory agencies regarding credentialing while developing and maintaining a working knowledge of the statutes, regulations, and laws.
• Ability to excel in a dynamic setting, adaptable, and resilient.
• Completion of organizational required education, setting goals and other assignments.

Qualifications

• Associate degree in business, healthcare management, or equivalent
• 1+ years Credentialing and Payer Enrollment experience
• Computer and MS Office workplace experience

TCN is committed to the work of anti-racism and pursuit of diversity, equity, and inclusion, to foster a safe and transformational environment for staff and patients to work, receive care, and thrive in their everyday lives. We strongly encourage all interested individuals to apply, even if they are not confident, they meet 100% of the listed qualifications, and allow us to evaluate candidates’ knowledge, skills, and abilities using an intentional equity lens.

• Process provider initial and reappointment applications; monitor and follow-up as needed to ensure timely appointments and privileges.
• Verification of provider credentials and the facilitation of initial appointment and reappointment.
• Ensure accurate and timely submission of credentialing and recredentialing applications for both organizations and individual providers; monitor and follow-up as needed to ensure credentialing compliance.
• Coordinate and assist in the enrollment, re-enrollment, revalidation, and submission of data/documents for providers and organizations so that they may submit claims for payment.
• Track and monitor documents of current state licenses, Drug Enforcement Agency certifications, malpractice coverage, specialty certifications, health records and other required credentialing documents to ensure the timely renewals for all providers and regulatory compliance.
• Maintain multiple Provider Credentialing Databases.
• Communicate with payers, providers, leadership, and other entities to support activities with regards to real-time information, schedules, provider requests and meetings.
• Assist in compliance with the accrediting and regulatory agencies regarding credentialing while developing and maintaining a working knowledge of the statutes, regulations, and laws.
• Ability to excel in a dynamic setting, adaptable, and resilient.
• Completion of organizational required education, setting goals and other assignments