Behavioral Health Authorization and Credentialing Specialist

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Acquire and uphold necessary authorizations for ICGH services.

• Submit initial and ongoing authorization requests within mandated payer timelines.

• Interact with insurance payers regarding authorization inquiries, approvals, denials, and requirements.

• Gather and review documentation essential for supporting authorization requests.

• Ensure precise authorization details are maintained in the EHR and authorization tracking system.

• Monitor the status of authorizations, approved units, and expiration dates.

• Collaborate with clinical and operational teams to gather information necessary for authorizations and ongoing reviews.

• Relay information on authorization approvals, limitations, denials, and issues to relevant teams.

• Track authorization appeals until resolution is achieved.

• Identify and resolve authorization issues that may affect services or billing.

• Oversee provider credentialing and enrollment with insurance payers.

• Prepare, submit, and monitor initial provider credentialing and enrollment applications.

• Track credentialing applications, follow up with payers, and address any outstanding requests for information or documentation.

• Maintain comprehensive provider credentialing records, including application status, effective dates, recredentialing deadlines, and enrollment criteria.

• Monitor provider recredentialing and payer revalidation requirements to ensure timely completion.

• Work with providers and internal teams to obtain necessary credentialing documentation and ensure accurate provider information is maintained.

• Communicate provider enrollment approvals, effective dates, and any unresolved credentialing issues to the appropriate teams.

• Identify and resolve credentialing or enrollment issues that may influence billing, reimbursement, or provider participation.

• Maintain thorough and accurate records for authorization and credentialing.

• Engage in authorization and credentialing audits and quality enhancement activities.

• Participate in departmental meetings and team initiatives.

• Assist with updates to workflows, tracking tools, and procedures related to authorization and credentialing.

• Support quality improvement efforts connected to authorization and credentialing processes.

• Execute other related duties as assigned.

⛳️ Requirements

• Knowledge of behavioral health services and insurance authorization processes.

• Familiarity with provider credentialing and insurance enrollment processes is preferred.

• Understanding of payer requirements and authorization procedures.

• Strong organizational and time-management abilities.

• Keen attention to detail and accuracy.

• Proficient written and verbal communication skills.

• Capability to manage multiple authorizations, credentialing applications, deadlines, and priorities.

• Ability to communicate effectively with insurance payers, providers, and internal teams.

• Capacity to maintain accurate and confidential records.

• Aptitude for identifying authorization and credentialing issues and following through to resolution.

• Ability to work both independently and collaboratively.

• Flexibility to adapt to evolving payer requirements and processes.

🏝️ Benefits

• [List benefits here]

• [List additional benefits here]