Credentialing Team LeaderHelp 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 Credentialing Team Leader today!
The Credentialing Team Leader
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 Team Leader is Responsible for leading credentialing department, including management of all relevant databases, rosters, internal/external checks, to ensure that clinical providers at all levels in the Center are appropriately credentialed to provide billable services to maintain Center revenue.
- Assists with processing of personnel changes, maintenance of general HR information, and event support.
- Weekly manage training of employees on credentialing.
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. Respond to requests for information within 2 business days.
- Has a servant attitude and behaviors as evidenced by no complaints from co-workers and team members.
- Embodies professionalism through daily teaming with Human Resources department.
- Work well with other departments as evidenced by co-worker and department supervisor report.
- Supervise team of credentialists, ensuring that all tasks are completed and deadlines for credentialing requirements are met. Effectively manage team members to achieve successful credentialing services for the Center's providers.
2. Coordinate the internal and external credentialing requirements in the Center for all licensed providers, following policy, procedures, and guidelines for insurance companies we contract with. Supervise team of credentialists to achieve the following tasks.
- Follow P&P to credential (60 days pre-hire or upon receipt of license from the State of Tennessee) and re-credential (every 3 years) eligible employees within designated timeframes, coordinating with appropriate HR team members to ensure all documentation received on time.
- Supervise and/or perform the following credentialing tasks, among others that may be required: i. Submit credentialing packets to Chief Medical Officer for approval.
- Upload credentialing packet to HRIS for electronic records and maintains paper files.
- Maintain centralized credentialing spreadsheet with approval timelines of newly licensed providers.
- Respond to credentialing audits, including Humana audit, by providing all requested documentation by deadlines.
- Maintain provider websites, typically including Optum, Availtiy, Magellan, Medicaid for State of TN, PECOS, NPPES, and others as required.
- Maintain rosters of non-licensed Master's level clinical providers, adding and removing staff as appropriate, for all contracted insurance companies.
- Submit quarterly rosters to 3 TennCare managed care organizations (MCOs) for non-licensed employees, following all guidelines set forth and ensuring all required documentation is included.
- Liaise with representatives for all TennCare MCOs, facilitating smooth credentialing of providers.
- Assist provider representatives with maintaining internal rosters for the organization.
- Apply for participating Medicaid and Medicare numbers for each licensed staff, corresponding with Provider Registration as appropriate to verify application status and ensure participation on Center rosters.
- Submit BCBS Provider enrollment Form (PEF) online application for each provider, including Professional Services Information (PSI) forms for all practice locations.
- Establish and maintain CAQH accounts for each credentialed employee on CAQH portal, including attestation every 90 days and annual upload of liability coverage. Complete internal continuous audits to ensure current and accurate information on CAQH profiles.
- Complete checklist of all licensed staff terminating from the Center, including submission of forms to appropriate insurance carriers, removal from CAQH/CMS I&A, and termination on rosters.
3. Work closely with other departments, including Financial Services (Accounts Receivable), Utilization Management, and Information Technology.
- Communicate with these departments on potential billing issues due to credentialing for providers.
- Work denials based on credentialing issues with financial services.
- Communicate regularly with AR to determine corrections on credentialing problems that could result in denials.
- Assists in correcting issues, 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 MCOs.
4. Other miscellaneous duties include:
- Facilitate semi-annual Humana credentialing audits.
- Maintain National Provider Database (NPDB) for all credentialed staff
- Complete BESMART enrollments for appropriate credentialed staff, including submitting attestation requirements for individual providers, including documentation as required by 3 TennCare MCOs and BCBS commercial contract.
- Attend various informational conferences related to credentialing procedures.
- 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.
- Remain familiar with NCQA, and work to ensure the Center stays in compliance with those regulations in collaboration with Credentialing Review Committee members.
COMPENSATION:
- Starting salary for this position is approximately $21.25 /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.
QUALIFICATIONS - Credentialing Team Leader
Education:
- Bachelor's degree preferred in the human services or business field and 3 years of HR/credentialing experience.
Experience / Knowledge:
- At least 3 years of related credentialing or HR experience.
- Computer experience in a health care setting required.
- Knowledge of medical billing preferred.
- Knowledge of human resource policies and employment law preferred.
- Clinical experience and knowledge preferred.
Physical/Emotional/Social - Skills/Abilities:
- Be able to work with internal and external customers to lead provider credentialing functions for the Center.
- Able to sit or stand for long periods and do close computer working.
- Hearing of normal tones.
- Some lifting occasionally up to 25 pounds.
- Requires speaking abilities and training techniques.
- Requires perception of speech.
- Must be able to comprehend basic instructions, interpret documents, apply abstract principles to a wide range of complex tasks.
- Advanced verbal and written communication, training skills.
- Communicating effectively in writing as appropriate for the needs of the audience.
- Active listening-giving full attention to what other people are saying, taking time to understand their issue, ask questions and not interrupt at inappropriate times.
Location:
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.
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