What are the responsibilities and job description for the Credentialing/Authorizations Specialist position at Lumina Revenue Cycle Management?
Lumina is a family owned business specializing in revenue cycle management solutions for medical and behavioral health providers. Pay is dependent upon experience.
- Education: A high school diploma or GED is typically required; an associate's degree is a plus.
- Experience: Some experience in medical billing, insurance authorization, or a related field is strongly preferred.
- Skills: Credentialing, Provider Enrollment, CAQH, Medicaid, Medicare, Prior Authorizations, Utilization Review, Insurance Verification, Behavioral Health Healthcare, Compliance, HIPAA, CARF, Joint Commission, Revenue Cycle Management
Responsibilities Include:
- Coordinate provider credentialing, recredentialing, and payer enrollment for behavioral health providers.
- Submit and track enrollment applications with Medicaid, Medicare, and commercial insurance carriers.
- Maintain provider records, licenses, certifications, liability insurance, and compliance documentation.
- Perform primary source verification and monitor credential expirations to ensure ongoing compliance.
- Verify insurance eligibility, benefits, and authorization requirements for behavioral health services.
- Initiate, submit, track, and follow up on prior authorization requests, denials, and appeals.
- Collect and maintain patient demographic, insurance, and clinical information to support medical necessity reviews and authorization requests.
- Serve as a liaison between providers, patients, and insurance companies to facilitate credentialing, authorizations, and reimbursement processes.
- Collaborate with internal teams and payer representatives to resolve credentialing and authorization issues.
- Maintain accurate data entry, reporting, and audit-ready records in compliance with HIPAA, CARF, Joint Commission, payer, and regulatory requirements.
Job Type: Full-time
Pay: From $11.00 per hour
Benefits:
- Dental insurance
- Flexible schedule
- Health insurance
- Vision insurance
Work Location: Hybrid remote in Van Buren, AR 72956
Salary : $11