Credentialing Specialist

PROVIDER SERVICES and CREDENTIALING SPECIALIST

On-site

Phoenix, AZ

As a provider services team member, you have a deep understanding of client funding sources, including insurance funding and ensure funding related information is documented accurately and timely. Additionally, you can identify errors and corrections that are needed to ensure the accuracy of records and billing. This position will provide additional support to obtain authorizations, reauthorizations, support with denials, and adjustments needed to authorizations. In addition, this position will be accountable for establishing and maintain provider credentialing.

Your Role at SARRC

Funding Documentation & Accuracy

• Deep Understanding of Funding Sources: Demonstrate a comprehensive knowledge of various client funding sources, including private insurance plans, AHCCCS/Medicaid, and other relevant funding streams for behavioral health services.
• Data Integrity & Auditing: Accurately and timely document all client funding and insurance-related information in relevant systems.
• Compliance & Record Keeping: Ensure all documentation adheres to payer, state, and federal compliance standards.
  
  

Authorization Management & Benefit Verification

• Authorization Processing: Efficiently manage the end-to-end process for obtaining initial authorizations and timely reauthorizations for client services.
• Denial and Appeal Support: Provide dedicated support in investigating and processing denials related to authorizations, collaborating with clinical and billing teams to compile necessary documentation for appeals and adjustments.
• Authorization Adjustments: Process and track necessary adjustments to existing authorizations based on changes in service intensity or client needs.
• Verifications: Navigate initial benefit verification for clients with multiple plans, denials, and requests for change of provider or insurance during an authorization period as instructed by Manager.
  
  

Provider Credentialing & Records Management

• Credentialing Expertise: Be the primary owner of the provider credentialing process.
• Establish and maintain comprehensive provider records, ensuring all licenses, certifications, and required documentation are current and compliant.
• Manage the application and re-credentialing process with all relevant payers (e.g., insurance companies, AHCCCS).
• System Maintenance: Maintain accurate and up-to-date credentialing information within all internal and external databases.
  

Required Qualifications

• High School Diploma or GED.
• Minimum of two (2) years’ experience within a specialized medical billing environment.
• Technical Knowledge:
• Knowledge of provider credentialing.
• Understanding of insurance authorizations procedures and policies.
• Knowledge of insurance guidelines, including:
• Medicare
• HMO, PPO
• Behavioral Health carve-outs
• Arizona Medicaid (AHCCCS)
• EAP services
• Knowledge of CPT, ICD-10, HCPCS coding.
• Experience with medical billing software and clearinghouse.
  

Preferred Qualifications

• Associate’s degree.
• Experience within behavioral health, specifically ABA.
  
  

Salary

Starts at $24/hr

Robust Benefits Package

• Up to 16 days per year paid time off and 8 paid holidays
• Medical, dental and vision insurance (majority of coverage paid for by SARRC)
• 401(k) with 50% company match up to 6%
• Mileage reimbursement
• Professional development annual benefit of $1000
  
  

Our Story

Established in 1997 by two mothers of children with autism and their developmental pediatrician, SARRC is an internationally recognized nonprofit with a mission to advance research and provide a lifetime of support for individuals with autism and their families. As the state of Arizona’s largest nonprofit serving the autism community, SARRC conducts innovative research, provides evidence-based practices, disseminates effective training, and builds inclusive communities.