- Coordinates prior-authorization for procedures, orders, or medications by verifying the correct authorization form, obtaining all necessary information to complete form, and submitting the form to the correct insurance plan.
- Works with patients and insurance companies to secure retroactive insurance coverage and authorizations.
- Tracks and follows up on all pending authorizations or requests for additional information depending upon payer guidelines to expedite the claim process.
- Notifies appropriate staff of approved medical or medication authorizations and enters approved authorizations into the EHR.
- Works closely with Utilization Review Coordinator, billing, providers, and clinical teams.
- Knowledgeable in inpatient and outpatient coding, including and understanding of behavioral health, medical and psych procedures, ICD-10-CM, CPT, HCPCS, primary care, and residential.
- Displays a courteous, professional, and positive demeanor with co-workers and others while performing essential duties.
- Promotes effective working relations, both within the department and with other departments, to facilitate the department and organization’s ability to meet its goals and objectives.
- Manages the end-to-end credentialing and recredentialing process for medical providers and clinically licensed therapists with Medicare, Medicaid, and commercial insurance payers.
- Maintains accurate and up-to-date records, ensuring compliance with all payer requirements, regulatory standards, and accreditation bodies.
- Coordinates and completes credentialing applications for Polara Health’s clinics and hospital facilities, including licensing, certifications, and insurance panel enrollments.
- Serves as a liaison between providers, internal departments, and external agencies to resolve credentialing issues and ensure timely approvals.
- Performs other duties as required.
- 21 years of age or older; or minimum 18 years old and licensed or certified under A.R.S. Title 32 and providing services within the personnel member’s scope of practice; or minimum 18 years old for select administrative positions
- Must be able to provide or obtain an AZDPS Level One Fingerprint Clearance Card
- Must possess and maintain a valid Driver License, current automobile insurance, and a driving record that meets the guidelines and requirements of the organization
- People – Passionately believes in people and embraces diversity
- Integrity – Does the right thing even when no one is looking
- Learning – Challenges old paradigms with critical thinking, curiosity and creativity
- Accountability – Sets an intentional culture of personal responsibility; believes everyone carries the load
- Relationships – Serves colleagues and consumers with love, empathy and compassion
- Office environment, travel within the community, as needed
- Heavy exposure/use of computers, cell phones, office phones, etc.
- Ability to sit for prolonged periods throughout work hours
- Must be able to occasionally lift and/or move 5 or more pounds
- Must be able to respond appropriately and effectively in crisis situations by using good judgment and following Polara Health protocols
We Offer the Following Benefits to Full Time Employees:
Medical * Dental * Vision * Short and Long Term Disability * Life Insurance * Health Savings Account * Flexible Spending Account * Employee Assistance Program * 401(k) * Up to 3 Weeks of Paid Time Off * 10 Paid Holidays per Year * Shift Pay (for select inpatient and residential positions) * Educational Reimbursement *
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of Labor.
