West Virginia Healthcare Authorization/Credentialing Specialist
PATH BEHAVIORAL HEALTHCARE
JOB DESCRIPTION
TITLE: Heathcare Authorization/Credentialing Specialist: West Virginia
REPORTS TO: CRO (Chief Revenue Officer)
WORK AREA: Home Office (West Virginia)
SUMMARY: Manages insurance authorization processes for behavioral health services,
ensuring proper approval and documentation for client treatments. The candidate will need to
have experience with out of network commercial insurance, single case agreements,
authorization follow-through with VACCN, as well as West Viriginia Medicaid authorization
requirements. The candidate will also be responsible for the timely credentialing of all staff, this
position ensures compliance with licenses and certifications, maintaining close collaborations
across departments like Billing and Operations. They actively address process improvements,
support audit processes, and uphold the highest standards in HIPAA guidelines and company
policies. Their overarching goal is to ensure both new and active staff members are always
compliant, reflecting the organization's commitment to excellence and integrity.
BLOODBORNE PATHOGEN CATEGORY I: Tasks with actual blood/body fluid exposure are not
included in this positions duties as the job requires therapeutic counseling only.
PRIMARY JOB DUTIES:
Review medical documentation and insurance requirements
Submit authorization requests to insurance providers
Verify patient insurance coverage and benefits
Track and follow up on authorization status
Communicate with healthcare providers and insurance companies
Resolve authorization denials and appeal processes
Ensure swift credentialing for all new hires, accurately reflecting any changes.
Monitor the credentialing status of both new and active staff, ensuring providers maintain valid
credentials, such as licenses and certifications, to practice legally within their specialization.
Actively track upcoming expirations for licenses, certificates, educational qualifications, and CAQH
Collaborate with the CCO, COO, and Operations to meet all compliance requirements, ensuring site
credentials and licenses are current and addressing any potential issues promptly
Provide regular updates to Operations and staff on current credentialing statuses through both routine
reports and immediate notifications
Work closely with the Billing team to maintain open communication with insurance companies about
contract changes and policy updates
Identify areas for process improvement and coordinate with relevant departments for streamlined
implementation
Oversee general training and manage updates within CareLogic
Conduct employee status audits and update IDs and employee information in CareLogic
Collaborate across departments to resolve any credentialing discrepancies
Support audit processes, providing essential assistance and information when required.
Stay informed on best practices for Medicaid provider credentialing as well as Commercial Payers as
we add them to our portfolio, ensuring the agency's compliance and efficiency in coordination with
Operations.
Uphold strict adherence to HIPAA guidelines, confidentiality protocols, billing and coding standards,
and company policies.
Take on additional tasks or responsibilities as assigned by the Operations Team and CRO.
QUALIFICATIONS
Education
Associate's or Bachelor's degree in healthcare administration
Experience/Skills
Knowledge of medical terminology
Understanding of insurance policies and procedures, including electronic claims processing and
insurance verifications.
Minimum of 3 years of experience in medical billing or credentialing, preferably within a behavioral
healthcare setting.
Proven experience overseeing a team, with a focus on optimizing productivity and performance.
Familiarity with billing software and electronic medical records (EMRs).
Strong understanding of medical coding and billing processes.
Comprehensive knowledge of healthcare accreditation and licensing standards.
Experience with payroll processes and related software.
Solid understanding of insurance procedures, contracts, and provider credentialing processes.
Strong communication skills
Attention to detail
Proficiency in healthcare software and electronic medical record systems, including medical billing
software
HIPPA compliance knowledge
Desired Skills
Medical coding certification
2-3 years healthcare authorization experience
Problem-solving abilities
Physical Effort: This position requires the ability to work under stressful conditions and to work
irregular hours. Requires sitting for extended periods of time, viewing computer monitors, and
keyboarding.
Communication Skills: must possess excellent verbal and written communication skills in order to
communicate professionally via telephone and in writing. Strong grammar and writing skills are
crucial for clear and concise communication with clients, colleagues, and other healthcare
professionals.
Interpersonal Skills: The successful candidate must demonstrate the ability to interact and assist in a
friendly, compassionate, and professional manner with colleagues, providers, clients, and their
families, as they represent both themselves and Path Behavioral Healthcare.
Essential Technical/Motor Skills: Candidates must achieve competency in the Electronic Health
Record (EHR) program, telemedicine services, and any additional software programs utilized by the
company, ensuring efficient access and updating of client information. The role requires fine
dexterity, adept handling, and proficient gripping abilities to perform various tasks.
Background: The candidate must pass all federal and state background checks, and their educational
and work history will be confirmed in compliance with company policies.
Apply Now
JOB DESCRIPTION
TITLE: Heathcare Authorization/Credentialing Specialist: West Virginia
REPORTS TO: CRO (Chief Revenue Officer)
WORK AREA: Home Office (West Virginia)
SUMMARY: Manages insurance authorization processes for behavioral health services,
ensuring proper approval and documentation for client treatments. The candidate will need to
have experience with out of network commercial insurance, single case agreements,
authorization follow-through with VACCN, as well as West Viriginia Medicaid authorization
requirements. The candidate will also be responsible for the timely credentialing of all staff, this
position ensures compliance with licenses and certifications, maintaining close collaborations
across departments like Billing and Operations. They actively address process improvements,
support audit processes, and uphold the highest standards in HIPAA guidelines and company
policies. Their overarching goal is to ensure both new and active staff members are always
compliant, reflecting the organization's commitment to excellence and integrity.
BLOODBORNE PATHOGEN CATEGORY I: Tasks with actual blood/body fluid exposure are not
included in this positions duties as the job requires therapeutic counseling only.
PRIMARY JOB DUTIES:
Review medical documentation and insurance requirements
Submit authorization requests to insurance providers
Verify patient insurance coverage and benefits
Track and follow up on authorization status
Communicate with healthcare providers and insurance companies
Resolve authorization denials and appeal processes
Ensure swift credentialing for all new hires, accurately reflecting any changes.
Monitor the credentialing status of both new and active staff, ensuring providers maintain valid
credentials, such as licenses and certifications, to practice legally within their specialization.
Actively track upcoming expirations for licenses, certificates, educational qualifications, and CAQH
Collaborate with the CCO, COO, and Operations to meet all compliance requirements, ensuring site
credentials and licenses are current and addressing any potential issues promptly
Provide regular updates to Operations and staff on current credentialing statuses through both routine
reports and immediate notifications
Work closely with the Billing team to maintain open communication with insurance companies about
contract changes and policy updates
Identify areas for process improvement and coordinate with relevant departments for streamlined
implementation
Oversee general training and manage updates within CareLogic
Conduct employee status audits and update IDs and employee information in CareLogic
Collaborate across departments to resolve any credentialing discrepancies
Support audit processes, providing essential assistance and information when required.
Stay informed on best practices for Medicaid provider credentialing as well as Commercial Payers as
we add them to our portfolio, ensuring the agency's compliance and efficiency in coordination with
Operations.
Uphold strict adherence to HIPAA guidelines, confidentiality protocols, billing and coding standards,
and company policies.
Take on additional tasks or responsibilities as assigned by the Operations Team and CRO.
QUALIFICATIONS
Education
Associate's or Bachelor's degree in healthcare administration
Experience/Skills
Knowledge of medical terminology
Understanding of insurance policies and procedures, including electronic claims processing and
insurance verifications.
Minimum of 3 years of experience in medical billing or credentialing, preferably within a behavioral
healthcare setting.
Proven experience overseeing a team, with a focus on optimizing productivity and performance.
Familiarity with billing software and electronic medical records (EMRs).
Strong understanding of medical coding and billing processes.
Comprehensive knowledge of healthcare accreditation and licensing standards.
Experience with payroll processes and related software.
Solid understanding of insurance procedures, contracts, and provider credentialing processes.
Strong communication skills
Attention to detail
Proficiency in healthcare software and electronic medical record systems, including medical billing
software
HIPPA compliance knowledge
Desired Skills
Medical coding certification
2-3 years healthcare authorization experience
Problem-solving abilities
Physical Effort: This position requires the ability to work under stressful conditions and to work
irregular hours. Requires sitting for extended periods of time, viewing computer monitors, and
keyboarding.
Communication Skills: must possess excellent verbal and written communication skills in order to
communicate professionally via telephone and in writing. Strong grammar and writing skills are
crucial for clear and concise communication with clients, colleagues, and other healthcare
professionals.
Interpersonal Skills: The successful candidate must demonstrate the ability to interact and assist in a
friendly, compassionate, and professional manner with colleagues, providers, clients, and their
families, as they represent both themselves and Path Behavioral Healthcare.
Essential Technical/Motor Skills: Candidates must achieve competency in the Electronic Health
Record (EHR) program, telemedicine services, and any additional software programs utilized by the
company, ensuring efficient access and updating of client information. The role requires fine
dexterity, adept handling, and proficient gripping abilities to perform various tasks.
Background: The candidate must pass all federal and state background checks, and their educational
and work history will be confirmed in compliance with company policies.
Apply Now