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USA

Authorization and Credentialing Coordinator

Chicago - Illinois (IL),

Trilogy Behavioral Healthcare

Job Description:

Overview

Trilogy Behavioral Healthcare Inc. strongly believes that treatment services are more effective when provided in the client’s natural setting, hence, the majority of services provided are located in the community. Trilogy Behavioral Healthcare Inc. also employs a holistic approach to each client’s treatment and integrates all facets of our clients’ lives including mental/emotional health, physical health/wellness, employment and education, social and family relationships, substance use/abuse issues, and housing needs.

Typical services provided include case management, counseling/therapy, individual skills training, medication training, crisis intervention, linkage to community resources, advocacy, assessment, and treatment planning.

Responsibilities

The Authorization and Credentialing Coordinator is senior level professional responsible for proactively working with Medicaid and Managed Care Organizations (MCOs) to ensure that Trilogy has all applicable credentialing on file. Additionally, they will obtain initial and re-authorizations for client services in order to maximize reimbursement and reduce denials.
Essential Responsibilities
  • Primary liaison with the state and MCO’s regarding authorization and eligibility review issues for the organization.
  • Responsible for obtaining proper credentialing with Illinois Department of Healthcare and Family Services (HFS) and MCOs.
  • Coordinate and educate employees regarding services provided and necessary steps to successfully obtain authorizations. Partner with clinicians to ensure documentation is timely and supports the services identified.
  • Submit and obtain updates regarding authorizations for service. Communicate with employee’s pertinent information about the clients or their authorizations
  • Review authorizations reports; and identify trends, issues, or barriers regarding obtaining authorizations to leadership
  • Communicate to employees when a client’s insurance has lapsed. Collaborate with new insurance to obtain authorization information.
  • Perform other related duties and/or projects as assigned


Qualifications

  • Bachelor’s degree in Finance, Psychology, Social Work, Counseling, Behavioral Health, or other closely related field highly preferred
  • Minimum 7 years of experience in the healthcare industry (particularly Medicaid and Managed Medicaid insurance companies)
  • Minimum of 5 years of healthcare revenue cycle experience (i.e. authorization, billing, coding, collections, or charge capture)
  • Thorough understanding of the authorization process with Medicaid payers
  • Experience with CareLogic system preferred
  • Strong understanding of Microsoft applications; i.e. Excel, Outlook, Access, Word
  • Ability to investigate problems and develop/communicate solutions
  • Excellent oral, written, and interpersonal communication skills with a focus on customer service
  • Ability to meet deadlines; highly detailed oriented; strong financial analysis and organizational skills; and analytical mindset with intellectual curiosity
  • Ability to act and operate independently with minimal supervision

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