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 II program today!

The Credentialist II

JOB PURPOSE/SUMMARY

Summary 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 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 Credentialing Specialist DCS & Medical Providers owns the full internal credentialing process for medical providers (MDs/APNs), collecting forms from staff, running clearances, requesting internal approval, adding staff to rosters, coordinating with internal teams to ensure compliance and reimbursement, as well as following up with insurance partners to verify credentialing is complete and accurate.
• The position will conduct all pre-hire and mid-employment checks for staff employed in DCS-related positions.
• The position will be responsible for semi-annual Humana audits and maintaining the National Provider Database for all credentialed staff.

TYPICAL WORKING CONDITIONS/ENVIRONMENT

• This position operates primarily out of administrative office with limited visits to clinics or other offices.

JOB DUTIES/RESPONSIBILITIES

This 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. Demonstrate professionalism through responsiveness, a positive work climate and cultural competency.

• Engage 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.
• Work well with other departments as evidenced by co-worker and department supervisor report.
• Embodies professionalism through daily teaming with financial services.

2. Coordinate the credentialing requirements in the Center for APNs and MDs, following policy, procedures and guidelines for insurance companies we contract with.

• Follow P&P to credential (60 days pre-hire or upon receipt of license from the State of Tennessee) and recredential (every 3 years) eligible employees within designated timeframes, coordinating with appropriate HR team members to ensure all documentation received on time.
• Submit credentialing packets to Chief Medical Officer for approval.
• Upload credentialing packet to HRIS for electronic records and maintains paper files.
• Respond to credentialing audits, providing all requested documentation by deadlines.
• Maintain rosters of non-licensed Master's level clinical providers, adding and removing staff as appropriate.
• Submit quarterly rosters to 3 TennCare MCOs for non-licensed employees, following all guidelines set forth and ensuring all required documentation included.
• Liaison with reps for all TennCare MCOs, facilitating smooth credentialing processes.
• Assist provider representatives with maintaining internal rosters for the organization.

3. Work closely with billing and follow up management within Financial Services.

• Communicate with AR on potential billing issues due to credentialing for providers.
• Work denials based on credentialing issues with AR.
• Meet regularly with AR to determine corrections on credentialing problems that could result in denials. Assists in process decreasing substantial loss of revenue due to non-payment.
• Correspond regularly with credentialing team and AR for updates on credentialing status for providers.
• Distribute rosters to AR simultaneously with submission to TennCare MCOs4. 

4.Support the Human Resources department with timely pre-hire and post-hire additional processing for all DCS-related positions.

• Collects background check and education verification consent forms.
• Complete background checks online with 24 hours of receiving consent forms and notifies HR Coordinator of any driving record that makes an employee ineligible for employment based on the HRMC Certified Driver Policy or any conviction that makes the employee potentially ineligible for hire.
• Sets up fingerprints and physical/TB screen with 24 hours of receiving consent forms.
• Prints background checks for pre-hire and post-hire packets to be filed in paper personnel file.
• Register new employees on TN New Hire website.
• Verify new employees' eligibility to work in the United States on the E-Verify website.
• Enters pre-hire and post-hire checks and forms (I-9, background checks, education verification, application, resume, references) into personnel management system.
• Register new employees on K-Checks website.
• Creates and sends new hire employment emails with job description to employee/supervisor within 3 days of receiving checklist. Prints for paper file and gives to HR Clerk for filing.
• Coordinates drug screening process and notifies HR Coordinator of any positive drug screens.
• Complete DCS spreadsheets by 5^th of each month and email them to Bethany Ellis (Bethany.ellis@tn.gov) with DCS.

5. Other miscellaneous duties include:

• Facilitate semi-annual Humana credentialing audits.
• Maintain National Provider Database (NPDB) for all credentialed staff.
• Schedule and assist with facilitation of multi-departmental meeting for improving processes, resulting in invoices paid properly.
• Attend various informational conferences related to credentialing processes.
• Support 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.
• Is familiar with NCQA and works to ensure the Center stays in compliance with those regulations in collaboration with Credentialing Review Committee members.

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/Technology:

• 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.

QUALIFICATIONS - Credentialist II

Education:

• High School Diploma required; Bachelor's preferred.

Experience / 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.

Physical:

• 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:

• Knoxville, Tennessee

Apply 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.