CREDENTIALING COORDINATOR

State of Franklin Healthcare Associates
Johnson City, TN Full Time
POSTED ON 2/19/2020 CLOSED ON 4/27/2020

Job Posting for CREDENTIALING COORDINATOR at State of Franklin Healthcare Associates

State of Franklin Healthcare Associates is currently seeking a Full-Time Credentialing Coordinator in Johnson City, TN. The Credentialing Coordinator completes credentialing and re-credentialing processes for all providers.

 

State of Franklin Healthcare Associates was voted as the Best Place to Work in the 2018 Johnson City Press Reader's Choice Award.

Essential Duties and Responsibilities

  • Credentials new providers and re-credentials existing providers to include completing the applications for:
    • Hospital and facility privileges
    • DEA and medical license address corrections
    • SVMIC malpractice insurance
    • Council for Affordable Quality Health Care (CAQH) - houses all providers information
    • NPI databank
    • Disclosure of Ownership
    • Participation in Medicare; and
    • Participation in State of Franklin Healthcare's payer agreements.
  • Coordinates credentialing paperwork with clinic managers to meet identified timeframe. Follows-up to ensure paperwork is returned.
  • Completes and maintains credentialing file for each provider.
  • Maintains contact with the insurance carrier to ensure applications are received and processed properly.
  • Maintains knowledge of individual insurance carrier requirements for credentialing.
  • Completes provider re-credentialing applications requested by third party payers and facilities.
  • Maintains and updates proper credentialing materials (state licenses, DEA, SVMIC, curriculum vita, and continuing medical education certificates) for providers' files.
  • Maintains and updates providers' participation status with insurance carriers for CBO staff and SoFHA clinic staff.
  • Maintains and updates provider rosters.
  • Maintains list of contact information and process by payer in the credentialing manual.
  • Appropriately evaluates insurance denials for "non-participating physician" or "out-of-network." Contacts insurance carriers as needed to correct participation status so that claims can be refiled and/or reprocessed correctly.

Other

  • Compiles information and prepares reports.
  • Maintains records.
  • Participates in educational activities.
  • Regular and in-person attendance as scheduled and required to perform essential job functions.
  • Follows organizational policies and procedures, including State of Franklin Healthcare Associates Compliance Manual, Code of Ethics and Business Standards, HR Policies and Procedures Manual, Team Member Handbook, OSHA Manual and any other policies or procedures for the job function, department, location or clinic.
  • Performs other duties as assigned.

Qualifications

Knowledge of application procedures for licensures, privileges and insurance carrier participation, insurance carrier operating procedures and practices and ability to complete the applications accurately and efficiently. Skill in using computer, calculator, copy and fax machine.

Education

High school diploma or GED

Experience

Two years of clerical experience with demonstrated initiative and self-direction or additional related education may be substituted for the two years of clerical experience.

Competencies

Service: Demonstrates high standards of service to patients, physicians, team members and other departments; remains calm when faced with challenging or difficult situations; effectively resolves service issues.

Quality: Work is thorough and accurate; offers ideas and solutions to improve outcomes and enhance service; considers the situation and relevant information before taking action; effectively implements improvements.

Integrity: Acts with the highest levels of personal ethics, honesty and accountability.

Performance: Applies job specific knowledge, skills and experience to accomplish results; requires appropriate level of supervision; work is completed in a timely manner; uses sound judgement in decision-making; is reliable and dependable; utilizes time and resources responsibly; complies with policies and procedures; work area is organized, neat and clean.

Communication: Expresses facts and ideas in a clear, convincing and organized manner; listens effectively; professional, respectful and compassionate in communications with others; follows proper channels of communication and shares essential information timely; maintains appropriate confidentiality.

Teamwork: Builds and maintains effective working relationships; recognizes strengths and contribution of others; manages and resolves conflicts in a positive and constructive manner.

 

Working Conditions

Work is performed in a medical office environment involving contact with patients, physicians, staff, insurance carriers and other business partners. Occasional local travel between work sites and additional hours, including evening or weekend work, may be necessary.

 

Physical Requirements

 

Not Required

Occasional

Frequent

Continuous

Walking

 

X

 

 

Standing

 

X

 

 

Sitting

 

 

X

 

Lifting

 

 

 

 

   up to 10 lbs

 

X

 

 

   up to 25 lbs

X

 

 

 

   up to 50 lbs

X

 

 

 

   Assisted lifting

X

 

 

 

Climbing

X

 

 

 

Pulling

 

X

 

 

Pushing

 

X

 

 

Vision

 

 

 

X

Color Vision

 

X

 

 

Hearing

 

 

X

 

Speaking

 

 

X

 

Chemicals/PPE

X

 

 

 

Pathogens/PPE

X

 

 

 

Outside Work

X

 

 

 

 

Coordinator
K-VA-T Food Stores Inc -
Johnson, TN
Coordinator
K-VA-T Food Stores Inc -
Blountville, TN
Freight Coordinator
Buckle -
Bristol, TN

Popular Search Topics

Salary.com Estimation for CREDENTIALING COORDINATOR in Johnson City, TN
$44,045 to $54,165
If your compensation planning software is too rigid to deploy winning incentive strategies, it’s time to find an adaptable solution. Compensation Planning
View Core, Job Family, and Industry Job Skills and Competency Data for more than 15,000 Job Titles Skills Library

Sign up to receive alerts about other jobs with skills like those required for the CREDENTIALING COORDINATOR.

Click the checkbox next to the jobs that you are interested in.

  • Certification and Accreditation Process Skill

    • Income Estimation: $54,064 - $64,420
    • Income Estimation: $65,973 - $87,404
  • Document Processing Skill

    • Income Estimation: $49,609 - $62,608
    • Income Estimation: $55,740 - $68,114
This job has expired.

Not the job you're looking for? Here are some other CREDENTIALING COORDINATOR jobs in the Johnson City, TN area that may be a better fit.

Credentialing Coordinator

STATE OF FRANKLIN HEALTHCARE ASSOCIATES PLLC, JOHNSON CITY, TN

Credentialing Coordinator

State Of Franklin Healthcare Associates Pllc, Johnson, TN