PROVIDER CREDENTIALING COORDINATOR

Executive Service

PROVIDER CREDENTIALING COORDINATOR

Department of Intellectual and Developmental Disabilities

Nashville, TN

$3,958 Monthly

Closing Date: 03/25/2024

This role is eligible for a hybrid work schedule, which provides for up to three days of work from home a week, two days in the office or upon supervisor request.

https://www.dropbox.com/scl/fi/y59i43ldu999mkyiloldd/Provider-Credentialing-Coordinator-2024-002.pdf?rlkey=6d1pfmoiz4kw2kl4cxmcwxy9m&dl=0

Who we are and what we do:

The Department of Intellectual and Developmental Disabilities is the state agency responsible for administration and oversight of community-based services for approximately 8,000 people with intellectual disabilities as well as 4,000 people through the Family Support Program. Every day, the department strives to support people to live rewarding and fulfilling lives. It does so by ensuring people are free to exercise rights, engage with their broader communities and experience optimal health. DIDD is the first and only state service delivery system in the nation to receive Person-Centered Excellence Accreditation from the Council on Quality and Leadership. It has also been recognized as a national leader in its efforts to increase competitive, community-based employment outcomes for people with disabilities.

Job Overview:

The Department of Intellectual and Developmental Disabilities (DIDD) is looking for a Provider Credentialing Coordinator to process applications for new providers requesting to come into the network, provider expansion requests, and for-credentialing. The position is an IDD Program Specialist 3 position under the supervision of the Director of Provider Credentialing and Provider Network Management.

This coordinator position will work with our existing Provider Enrollment Coordinator and Director of Provider Credentialing and Network Management to perform administrative tasks relating to PROVIDER CREDENTIALING and re-credentialing. This coordinator will organize, maintain, and verify various aspects of the process, and maintain current files on applicants. This position will support 1915c, Employment and Community First (ECF), Dual CHOICES providers, and Katie Becket (Parts A and B) programs. The coordinator position will work with DIDD Office of Business Services (OBS), Managed Care Organizations (MCOs) and DIDD Provider Supports to ensure the onboarding process is started once credentialing is granted (provider registration, contract initiation, etc.) and appropriate actions are taken upon re-credentialing.

Key Responsibilities:

• Process initial credentialing applications.
• Process expansion requests.
• Establish initial re-credentialing dates for a provider once they have been credentialed and completed the contracting process.
• Coordinate Provider Supports re-credentialing reviews .
• Track expiration of credentialing status.
• Handle notifications to the applicants throughout the credentialing process and re-credentialing process.
• Screen applications and supporting documentation to determine eligibility.
• Collect information from the provider and from other sources such as the Council for Affordable Quality Healthcare (CAQH), Provider Data Management System (PDMS), Disclosure of Ownership (DOO) File, Quality Assurance/Quality Management staff, etc.
• Identify discrepancies in information and conduct follow-ups.
• Present applications to the Provider Credentialing Committee.
• Assist customers with credentialing inquiries.
• Capture primary source documentation in credentialing databases (i.e. SharePoint or Access).
• Track various items such as the expiration of trainings and certifications.
• Keep the internal comprehensive provider listing updated.
• Assist with facilitation of the New Provider Applicant Forum.
• Coordinate and assist with the development of a New Provider training module.
• Create or provide input into various monthly, quarterly, or as needed reports.
• Follow-up on re-credentialing barriers or concerns.

Required Experience:

Experience equivalent to three years of professional developmental disabilities and/or mental health work, of which one year must include professional developmental disabilities work.

Minimum Qualifications:

Bachelor's Degree required in special education, rehabilitation or therapeutic health, nursing, sociology, social work, or any behavioral science field.

OR

Qualifying professional developmental disabilities or mental health work may

substitute for the required education on a year-for-year basis to a maximum of four years

Pursuant to the State of Tennessee¿s Workplace Discrimination and Harassment policy, the State is firmly committed to the principle of fair and equal employment opportunities for its citizens and strives to protect the rights and opportunities of all people to seek, obtain, and hold employment without being subjected to illegal discrimination and harassment in the workplace. It is the State¿s policy to provide an environment free of discrimination and harassment of an individual because of that person¿s race, color, national origin, age (40 and over), sex, pregnancy, religion, creed, disability, veteran¿s status or any other category protected by state and/or federal civil rights laws.