Insurance Authorization & Provider Credentialing Specialist

Ascend Autism•Town of Mount Pleasant, NY

1d•$45,000 - $55,000•Hybrid

About The Position

The Insurance Authorization & Provider Credentialing Specialist works with the clinical and operations team at Ascend Autism to actively manage insurance authorizations for our services as well as manage the on-going credentialing of our clinical staff with numerous commercial and Medicaid insurance companies. The Specialist will be comfortable working with numerous team members, locally and at satellite locations, on a number of outstanding projects at any given time. The role requires a very well-organized individual with experience speaking with insurance companies and actively tracking many outstanding tasks. The position will also support and participate in Ascend’s Insurance and Revenue Cycle Management activities, and report to the Director of RCM.

Requirements

Bachelor’s degree or equivalent in education and experience
Must demonstrate strong analytical and problem-solving skills with attention to detail and accuracy
Must be a motivated individual with a positive and exceptional work ethic
Strong time management skills including planning, organization, multi-tasking, and ability to prioritize required
Must demonstrate effective communication skills both verbally and written
Demonstrated proficiency of Microsoft Office (Word & Excel) or similar software
Excellent communication and interpersonal skills
Ability to collaborate and communicate with BCBAs, support staff, parents, and clients in a positive and constructive way
Excellent organizational skills
Proficient with Microsoft Office Suite or related software as required for recordkeeping and documentation

Nice To Haves

Insurance verification: 1 year (Preferred)
Medical billing: 1 year (Preferred)

Responsibilities

Verifies insurance eligibility and benefits regarding client Applied Behavior Analysis (ABA) services
Obtain authorizations for services and on-going management of authorizations and re-authorizations
Monitor and escalate authorization issues
Performs provider enrollment and credentialing, data maintenance activities and payer enrollments
Perform data entry and document imports to maintain provider profiles and track application / credentialing / enrollment status
Work closely with key internal and external stakeholders to complete comprehensive audits of credentialing, demographic and participation data, performing timely corrections as deficiencies are identified
Log, troubleshoot and track enrollment, credentialing, contractual, fee schedule and demographic payer and provider issues
Conduct proactive and timely internal and external verification initiatives and roster audits
Verify credentials by searching third party databases, determining validity of data and documents received and accepting/rejecting information accordingly