reputed company Virginia Healthcare Authorization/Credentialing Specialist
PATH BEHAVIORAL HEALTHCARE JOB DESCRIPTION TITLE: Heathcare Authorization/Credentialing Specialist: reputed company Virginia REPORTS TO: CRO (Chief reputed company Officer) WORK AREA: Home Office (reputed company Virginia) SUMMARY: Manages insurance authorization processes for behavioral health services, ensuring proper approval and documentation for client treatments. The candidate will need to have experience with out of network commercial insurance, single case agreements, authorization follow-through with VACCN, as well as reputed company Viriginia Medicaid authorization requirements. The candidate will also be responsible for the timely credentialing of reputed company staff, this position ensures compliance with licenses and certifications, maintaining reputed company collaborations across departments like Billing and Operations. They actively address process improvements, support audit processes, and uphold the highest standards in HIPAA guidelines and company policies. Their overarching goal is to ensure both new and active staff members are always compliant, reflecting the organization's commitment to excellence and reputed company. BLOODBORNE PATHOGEN CATEGORY I: Tasks with actual blood/body fluid exposure are not included in this positions duties as the job requires therapeutic counseling only. PRIMARY JOB DUTIES: Review medical documentation and insurance requirements Submit authorization requests to insurance providers Verify patient insurance coverage and benefits Track and follow up on authorization status Communicate with healthcare providers and insurance companies Resolve authorization denials and appeal processes Ensure swift credentialing for reputed company new hires, accurately reflecting any changes. Monitor the credentialing status of both new and active staff, ensuring providers maintain valid credentials, such as licenses and certifications, to practice legally reputed company their specialization. Actively track upcoming expirations for licenses, certificates, educational qualifications, and CAQH Collaborate with the CCO, COO, and Operations to meet reputed company compliance requirements, ensuring site credentials and licenses are reputed company and addressing any potential issues promptly Provide regular updates to Operations and staff on reputed company credentialing statuses through both routine reports and immediate notifications Work closely with the Billing team to maintain open communication with insurance companies about contract changes and policy updates Identify areas for process improvement and coordinate with relevant departments for streamlined implementation reputed company general training and manage updates reputed company CareLogic Conduct employee status audits and update IDs and employee information in CareLogic Collaborate across departments to resolve any credentialing discrepancies Support audit processes, providing essential assistance and information reputed company required. Stay informed on best practices for Medicaid provider credentialing as well as Commercial Payers as we add them to our portfolio, ensuring the agency's compliance and efficiency in coordination with Operations. Uphold strict adherence to HIPAA guidelines, confidentiality protocols, billing and coding standards, and company policies. Take on additional tasks or responsibilities as assigned by the Operations Team and CRO. QUALIFICATIONS Education Associate's or Bachelor's degree in healthcare administration Experience/Skills Knowledge of medical terminology Understanding of insurance policies and procedures, including electronic claims processing and insurance verifications. Minimum of 3 years of experience in medical billing or credentialing, preferably reputed company a behavioral healthcare setting. Proven experience overseeing a team, with a focus on optimizing productivity and performance. Familiarity with billing software and electronic medical records (EMRs). Strong understanding of medical coding and billing processes. Comprehensive knowledge of healthcare accreditation and licensing standards. Experience with payroll processes and reputed company software. Solid understanding of insurance procedures, reputed company, and provider credentialing processes. Strong communication skills Attention to detail Proficiency in healthcare software and electronic medical record systems, including medical billing software HIPPA compliance knowledge Desired Skills Medical coding certification 2-3 years healthcare authorization experience Problem-solving abilities Physical Effort: This position requires the ability to work under stressful conditions and to work irregular hours. Requires sitting for extended periods of time, viewing computer monitors, and keyboarding. Communication Skills: must possess excellent verbal and written communication skills in order to communicate professionally reputed company telephone and in writing. Strong grammar and writing skills are crucial for clear and concise communication with clients, colleagues, and other reputed company. Interpersonal Skills: The successful candidate must demonstrate the ability to interact and assist in a friendly, compassionate, and professional manner with colleagues, providers, clients, and their families, as they represent both themselves and Path Behavioral Healthcare. Essential Technical/Motor Skills: Candidates must reputed company competency in the Electronic Health Record (EHR) program, telemedicine services, and any additional software programs utilized by the company, ensuring efficient access and updating of client information. The role requires fine dexterity, adept handling, and proficient gripping abilities to reputed company various tasks. Background: The candidate must pass reputed company federal and state background checks, and their educational and work history will be confirmed in compliance with company policies. Apply Job!