Credentialist I

Company: Helen Ross McNabb Center
Location: Knoxville
Posted on: March 1, 2025

Job Description:

Credentialist I
Help Others, Make a Difference, Save a Life.Do you want to make a difference in people's lives every day?
Or help people navigate the tough spots in their life?
And do it all while working where your hard work is appreciated?You have a lot of choices in where you work---make the decision to work where you are valued!Join the McNabb Center Team as the Credentialist I today!The Credentialist IJOB PURPOSE/SUMMARYSummary of role of team:

• The Human Resources team provides an array of services to support all Center staff.
• The Credentialing team specifically works to ensure that clinical providers meet all requirements to secure reimbursement for services provided on behalf of the Center.Summary of position:
  • Credentialists 1 (Internal) work closely with our providers and our insurance partners to guarantee staff are cleared and rostered in a timely manner to allow for service reimbursement.
  • The Credentialist 1 is responsible for completing all internal credentialing for licensed providers, including: CAQH maintenance and ensuring all other participation documentation is accurately completed and submitted on time.
  • This staff will regularly coordinate with internal teams to ensure compliance and reimbursement as well as perform any needed follow up with insurance partners to verify credentialing is complete and accurate.TYPICAL WORKING CONDITIONS/ENVIRONMENTThis position operates primarily out of administrative office with limited visits to clinics or other offices.JOB DUTIES/RESPONSIBILITIESThis job description is not intended to be all-inclusive; and employee will also perform other reasonably related job responsibilities as assigned by immediate supervisor and other management as required. This organization reserves the right to revise or change job duties as the need arises. Moreover, management reserves the right to change job descriptions, job duties, or working schedules based on their duty to accommodate individuals with disabilities. This job description does not constitute a written or implied contract of employment.1. Demonstrates professionalism through responsiveness, a positive work climate, and cultural competency.
    • Engages supervisors in a positive, professional manner with a servant attitude and continually follow up if there are any outstanding items the staff needs to turn in.
    • Has a servant attitude and behaviors as evidenced by no complaints.
    • Works well with other departments as evidenced by co-worker and department supervisor report.
    • Embodies professionalism through daily teaming with financial services.2. Coordinates the internal credentialing requirements for the Center, following policy, procedures, and guidelines for insurance companies we contract with.
      • Follows P&P to credential eligible employees within designated timeframes, coordinating with appropriate team members as necessary.
      • Provides updated internal credentialing documentation to the External Credentialist I to ensure that the quarterly, monthly, and as needed rosters are updated and submitted to all of the contracted insurance companies.
      • Maintains provider websites and rosters, ensuring all information is current and accurate for new staff, current staff, and terminated staff.
      • Website tasks typically to include: PECOS (Medicare) and I&A
      • Distributes internal credentialing complete memo to provider and all relative staff when all the internal processes are completed.
      • Maintains CAQH accounts for each credentialed employee on CAQH portal, including attestation every 90 days and upload of annual liability coverage.
      • Responsible for continual audits to ensure current and accurate information provided on profiles.
      • Complete checklist for all licensed staff terminating from the Center.
      • Work closely with billing and follow up management within Financial Services.
      • Communicate with Accounts Receivable (AR) on potential billing issues due to credentialing for providers.
      • Correspond regularly with credentialing team and AR for updates on credentialing status for providers.3. Other miscellaneous duties include:
        • Sits on credentialing committee, TAMHO monthly provider calls, and attends various informational conferences related to credentialing processes.
        • Supports credentialing team members as assigned.
        • Work closely with members of the HR team on various other duties as needed.
        • Miscellaneous reporting duties on an as needed basis.COMPENSATION:
          • Starting salary for this position is approximately $17.24-$17.90 /hr based on relevant experience and education.Schedule:
            • Must be able to have excellent attendance and start the workday at assigned time.
            • Typical administrative office hours are Monday-Friday from 8am-5pm daily.
            • Flexibility is determined on a case-by-case basis with the supervisor & leave requests require supervisor approval.Travel:
              • This position is office-based with some occasional travel to other Center offices for training or duties.Equipment/Technical Competency:
                • Must have excellent computer skills (especially Excel) and the ability to learn new software products quickly.
                • Must be able to complete a large amount of computer data entry and communication with supervisors daily.
                • Should be proficient on a variety of office equipment, including: copier, scanner, fax machine, computer desktop/laptop, telephone, etc.Equipment/Technology:
                  • Must be able to use a computer, telephone, and office equipment to complete job duties.QUALIFICATIONS - Credentialist IExperience / Knowledge:
                    • Computer experience in a health care setting required.
                    • Human resource, credentialing, or medical billing preferred.
                    • Knowledge of human resource policies and employment law preferred.
                    • Clinical experience and knowledge preferred.Education / License:
                      • Bachelor's degree or high school diploma with at least 1 year of direct provider credentialing experience required.Physical/Emotional/Social - Skills/Abilities:
                        • Must be able to do long periods of sitting and standing.
                        • Close computer work required.
                        • Must be able to see with correction, hear normal tones, and talk on phone / in person.
                        • Excellent interpersonal & communication skills needed. Ability to role-model preferred.
                        • Must be able to work effectively in a team with various personalities.Location:
                          • Knox County, TennesseeApply today to work where we care about you as an employee and where your hard work makes a difference!Helen Ross McNabb Center is an Equal Opportunity Employer. The Center provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment.Helen Ross McNabb Center conducts background checks, driver's license record, degree verification, and drug screens at hire. Employment is contingent upon clean drug screen, background check, and driving record. Additionally, certain programs are subject to TB Screening and/or testing. Bilingual applicants are encouraged to apply.
                            
                            
                            
                            
                            
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Keywords: Helen Ross McNabb Center, Knoxville , Credentialist I, Other , Knoxville, Tennessee