Insurance Authorization, Eligibility and Credentialing Coordinator
Trumpet Behavioral Health - Lakewood, CO

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Eligibility Responsibilities
  • Make all calls to managed care/healthcare provider to insure that potential patients are duly authorized to receive company-provided services
  • Maintain very accurate and detailed spreadsheets of all clients and communication with the healthcare providers
  • Maintain a working knowledge of Medicaid/TriCare/Commercial programs and the managed care referral and authorization processes for each
  • Build relationships with the appropriate contacts with each public or private healthcare payor
  • Able to be very aggressive in determining the correct information from the payors to insure that correct benefit, eligibility and authorization information is verified for the cpmpany-provided services
  • Develop procedures and track trends that insure the most accurate and streamlined process for obtaining authorizations and benefit information.
  • Keep all patient information confidential
  • Be able to work well with the internal clinical team and billing agents to insure proper process flow.
  • Ability to meet all turnaround time metrics
o Benefits Eligibility Verification form completed for all clients with 100% accuracy

Credentialing Coordinator Responsibilities
  • Ability to keep very detailed spreadsheets regarding daily interaction with insurance plans on credentialing status
  • Maintain turnaround expectations for submission of applications to insurance plans
o Timely submission of credentialing initiation of application to appropriate healthcare plans
o Weekly updates from insurance plans on status of all outstanding providers
o Completion of credentialing with provider effective dates within standard turnaround time within each insurance plan
  • Follow up with each insurance plan until the provider has an effective date
  • Responsible for credentialing of all managed care plans
Additional Requirements:
  • Ability to muli-task and communicate effectively across business boundaries
  • Ability to be self-directed with the appropriate amount of training
  • Ability to maintain an organized and efficient process to allow for quick and easy access to information while maintaining appropriate confidentiality requirements
  • Ability to ask questions and act to secure required information in a timely manner
Required Skills

Education:
This candidate will have an associates degree or applicable experience

Proficient use of Word Documents and Excel spreadsheets

Required Experience

Experience:
2 or more years expereince in both credntialing and eligibility verification process
Experience navigating the processes and challenges associated with the eligibility and credentialing process
Experience using various software tracking products

Trumpet Behavioral Health - 2 years ago - save job - copy to clipboard
About this company
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Trumpet Behavioral Health is a leading provider of behavioral health services. We specialize in the treatment of children and adolescents...