Provider Services & Credentialing Specialist

PROVIDER SERVICES SPECIALIST

Position Summary: 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

• Complies fully with all medical records and information privacy regulations, local, state and federal.
• Responds to direction from Provider Services Manager and can organize and plan work with little oversight to accomplish goals.
• Navigates 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.
• Documents all work within electronic systems following processes and procedures outlined by department.
• Collaborates proactively and clearly with providers, and other SARRC departments that interact daily with the team.
• Maintains prompt, professional communication and collaborates with Manager, Providers, and Medical Billing Staff to resolve problematic and/or complex issues.
• Maintains appropriate documentation according to professional, state, and federal requirements..
• Verifies, monitors, and assist with insurance verification as needed.
• Initiates comprehensive phone contact with providers, requesting additional information to accomplish goals.
• Adheres to the established criteria and timeframes for processing authorizations or corrections.
• Provides excellent customer care and hospitality with clear communication to assist customers (both internal and external) with their questions/concerns.
• Processes initial and maintains credentialing for providers across the organization.
• Performs other special projects and duties as necessary and requested.
  
  

Who You Are

• High School diploma or GED, with Associates Degree preferred (years of experience may be considered).
• Knowledge of provider credentialing.
• Minimum of two years of experience in a medical billing environment within a medically specialized enterprise.
• Understanding of insurance authorizations procedures and policies.
• Knowledge of ABA CPT codes is preferred.
• Knowledge of insurance guidelines; including Medicare, HMO, PPO, Behavioral Health carve-outs, Arizona Medicaid (AHCCCS) and EAP services.
• Knowledge of CPT, ICD-10, HCPCS coding.
• Experience with medical billing software and clearinghouse.
  
  

Salary

Starts at $21/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.