Provider Enrollment & 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.