Overview:
The Credentialing Coordinator plays a key role in the credentialing and onboarding processes for Tribeca Pediatrics providers, ensuring compliance with regulatory standards and organizational policies. This role involves collecting, verifying, and maintaining provider credentials, facilitating the payor application process, and collaborating with various departments to support the organization's operational needs. The Credentialing Coordinator is also responsible for managing insurance contracts and communicating with payor and provider teams.

Roles and Responsibilities:

Serve as the primary point of contact for providers regarding credentialing inquiries and processes.
Create provider profiles and input provider information into credentialing databases and EMR systems.
Collect and verify the credentials of pediatric providers, including education, training, licensure, and certifications.
Track the expiration of licenses and certifications for all providers and ensure timely renewals.
Maintain provider CAQH profiles, AMA profiles, and NPDB continuous queries.
Send provider pre-hire items (e.g., reference requests, intake applications, background checks) and track completion. Report findings to the manager.
Process applications for initial appointments and reappointments of hospital privileges as needed.
Submit and track credentialing and re-credentialing applications to insurance companies and regulatory bodies.
Maintain accurate and up-to-date credentialing records in the credentialing databases, ensuring compliance with legal and accreditation standards.
Stay updated with credentialing policies and procedures specific to pediatric care.
Work closely with credentialing management, human resources, provider staff, and compliance departments to streamline the credentialing process.
Respond to internal and external audits related to credentialing and compliance.
Apply for delegated credentialing with insurance payors.
Manage the credentialing inbox.
Coordinate the additions, updates, and terminations of providers from insurance contracts within the payors’ specified timeframes.

Qualifications:

3+ years of experience in healthcare credentialing or related administrative roles.
Familiarity with regulatory requirements and accreditation standards (e.g., NCQA, CMS, NY/NJ State Credentialing Requirements).
Exceptional organizational skills and attention to detail.
Excellent communication and interpersonal skills.
Ability to work independently in a remote setting and manage multiple tasks efficiently.
Reliable internet access.
Strong Excel skills preferred.
Must be comfortable with ever-changing priorities in a fast-paced environment.

Environmental/Working Conditions:

This is a fully remote position, requiring reliable internet access and a quiet workspace. Meetings will be conducted via video conferencing.

Physical Demands:

Requires sitting and standing associated with a normal office environment. Manual dexterity is needed for using a computer keyboard. While performing the duties of this position, the employee is regularly required to talk or hear. The employee needs to be able to see and is frequently required to use hands or fingers to handle or feel objects. The employee is occasionally required to stand, walk, sit, and reach with hands and arms.

Additional Notes:

This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in the position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties as requested by any person authorized to give instructions or assignments.