Insurance Authorization & Provider Credentialing Specialist

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.

JOB DUTIES & 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

EDUCATION, EXPERIENCE, & SKILLS

• 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

Salary : $45,000.00 - $55,000.00 per year

Benefits :

• 401(k) matching
• Flexible schedule
• Paid time off
• Tuition reimbursement
• Hybrid remote schedule

Experience :

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

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Ascend is an Equal Opportunity Employer. It is our policy to make all personnel decisions without discriminating based on race, color, creed, religion, sex, physical disability, mental disability, age, marital status, sexual orientation, citizenship status, national or ethnic origin, and any other protected status.