Credentialing & Prior Authorizations Specialist

Join Our Team as a Credentialling & Prior Authorizations Specialist

Full-Time – Center based

Welcome to Inspire Horizons!

We’re a clinician led pediatric therapy organization committed to supporting children with developmental delays and disabilities. Our approach brings together experts in Occupational Therapy, Speech Therapy, Feeding Therapy, and Applied Behavior Analysis (ABA) to create a collaborative environment where our clients and their families can thrive.

Position Overview:

We are seeking a detail-oriented and highly organized Credentialing and Prior Authorizations Specialist to join our team. This role is responsible for managing provider credentialing, re-credentialing, and prior authorization processes to ensure compliance with regulatory and payer requirements. The ideal candidate will have experience in medical credentialing, insurance authorizations, and a strong understanding of healthcare compliance.

Compensation:

• $52,000- $62,000
  
  

Work Schedule:

• Mon. - Fri. 7:00am - 4:00pm (1hr lunch)
  
  

Key Responsibilities:

• Manage and process initial credentialing and re-credentialing applications for providers with insurance payersand other healthcare organizations
• Maintain up-to-date provider files and ensure compliance with accreditation standards and payer requirements
• Coordinate and track prior authorization requests for Speech, Occupational, and ABA Therapies for pediatric centers
• Communicate with insurance companies, healthcare providers, and patients to facilitate approvals and resolve authorization issues
• Monitor and follow up on outstanding credentialing and authorization requests to prevent delays in patient care and provider reimbursements
• Ensure accuracy and completeness of credentialing applications and authorization documentation
• Stay informed about changes in insurance policies, credentialing standards, and prior authorization procedures
• Collaborate with billing, compliance, and administrative teams to streamline workflows
  
  

Requirements:

• 3 years of experience in credentialing, prior authorizations within a healthcare setting
• Certified Practitioner Credentialing Specialist (CPCS) preferred, not required
• Experience in verifying NPI’s, Licensures and use of related portals
• Advanced management of APEP and CAQH
• Experience with Arizona Medicaid and all MCO’s, Blue Cross Blue Shield of Arizona and all Commercial payers
• Experience with DDD and FOCUS and HCBS certifications
• Knowledge of CPT codes, medical terminology, insurance guidelines, and prior authorization requirements
• Excellent communication and interpersonal skills to interact with providers, payers, and team members
  
  

Excellent benefits:

• Health, vision, and dental benefits
• 401K (4%match)
• 8 closed paid holidays (1 floating holiday)
• 10PTO days
  
  

Equal Opportunity Employment:Inspire Horizons is an equal opportunity employer. We welcome applications from individuals of diverse backgrounds, including BIPOC,LatinX, LGBTQ , and those with disabilities. If you require accommodations during the application or interview process, please contact us. Your information will be handled confidentially in accordance with EEO guidelines.

Apply Now:Join Inspire Horizons and make a meaningful impact on children's lives!

For more information or to apply, please visitInspire Horizons Career Page.

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