Sr. Authorization & Credentialing Coordinator

Trilogy Behavioral Health

Job Description

The Senior Authorization and Credentialing Coordinator is senior level professional responsible for proactively working with Medicare, Medicaid, Managed Care Organizations (MCOs), and private insurances 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. 

  • Primary liaison with the state, Medicare, MCO’s, and private insurance plans regarding authorization and eligibility review issues for the organization.
  • Ensure that all Provider and site-level credentialing are up to date. Partner with employees regarding needed documentation.
  • Responsible for obtaining proper credentialing with Medicare, Illinois Department of Healthcare and Family Services (HFS), MCOs, and private insurances
  • 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

  • Bachelor’s degree in Finance, Psychology, Social Work, Counseling, Behavioral Health, or other closely related field highly preferred
  • Minimum 5-7 years of experience in the healthcare industry (particularly Medicaid and Managed Medicaid insurance companies)
  • Minimum of 3-5 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 ICD-10 coding. Billing and coding certification highly preferred
  • Prior experience with Lean Six Sigma and Process Improvement methodology
  • 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