Credentialing & Authorization Specialist

Boost; United States; On-site; USD 48,152 - 64,917; Full time

Job summary

A healthcare solutions provider in the United States is seeking a Credentialing & Authorization Specialist to manage the submission of provider credentialing requests and prior authorizations. The ideal candidate has strong attention to detail, organizational skills, and a passion for client experiences. This entry-level, full-time role involves communication with insurance companies and ensuring all requests are submitted promptly and accurately. The position offers a salary range of $48,152 to $64,917.

Qualifications

• Strong understanding of various funding source types.
• Experience in health care provider credentialing.
• Ability to document actions efficiently.

Responsibilities

• Collect and review documents for credentialing requests.
• Submit and follow up on authorization requests.
• Maintain communication with team and leadership.

Skills

Attention to detail

Organizational skills

Client experience

Job description

Credentialing & Authorization Specialist

The Credentialing & Prior Authorization Specialist is responsible for the accurate and timely submission of provider credentialing requests and prior authorizations, while maintaining the quality and productivity standards set for the position. The team member is expected to collect documentation to submit and follow up on provider credentialing with insurance companies in an efficient manner, as well as initiate new contract requests. This team member is not responsible for negotiating payor rates with insurance.

The role is responsible for prompt submission and follow up of new and continuing prior authorization requests to avoid any delays in patient care. The ideal candidate has a strong understanding of various funding source types, attention to detail, a passion for contributing to exceptional client experiences, and excellent organizational skills.

Responsibilities:

• Collect and review documents needed to submit provider credentialing requests to various insurance companies
• Prompt submission of credentialing requests and frequent follow-up on requests until response received from insurance companies
• Initiate new insurance contract requests on behalf of providers
• Collect and review documents needed to submit prior authorization requests to various insurance companies
• Prompt submission and frequent follow-up on authorization requests until response received from insurance companies
• Relay to leadership any denials, requests for more information, or other responses from insurance regarding contracts, credentialing, and prior authorizations
• Document all actions and updates in practice management system(s)
• Follow all company policies and procedures.
• Maintain frequent communication with team and department leadership to ensure a consistent flow of information.
• Other tasks as assigned.

Key Performance Measures:

• Submission of new contract, credentialing, or prior authorization requests within 2 business days of receipt of all required documentation
• Maintain follow-up schedule each week on all open requests
• Client satisfaction as it relates to contracting, credentialing, and authorizations

Seniority Level

Entry level

Employment Type

Full-time

Job Function

Health Care Provider

Industries

Software Development

United States $48,152.00 – $64,917.00