Case Management & Credentialing Manager - Melville, NY

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  Wage: TBD
  Department: Administrative
  Position Type: Full Time
  Location: Melville, NY

Achieve Beyond is a national Pediatric Therapy and Autism Services agency. With offices in New York (Metro area/Long Island, Hudson Valley & Albany), New Jersey, Virginia/DC area, Connecticut, Minnesota, Maryland, Delaware, and California (greater Los Angeles & Orange County, and San Diego). Achieve Beyond provides quality evaluation and therapy services such as special education, autism services, speech, physical, and occupational therapies to children birth through twenty-one years of age via telehealth, in clinic and in homes and the community.

Oversee the Case Management and Credentialing Departments and all functions for the departments by onboarding and maintaining provider compliance as well as ensuring all documentation is received and maintained for all current cases.

We believe that all children have potential. We are guided by the mission to support children with special needs to Achieve Beyond their current abilities. We are always striving for continuous improvement by setting goals and measuring performance.

It is the reason we will succeed together.

Responsibilities:

  • Assist Case Managers and Credentialing Coordinators with daily tasks when needed
  • Regular communication with office staff and therapists via email/phone.
  • Bi-annual verbal verification of all insurance for all cases (may require overtime)
  • Place cases on-hold if there are authorization issues-notify therapists via email and office staff
  • Collection/ tracking of all therapist reports i.e. assessments, reassessments, discharge and termination
  • Ensure new authorizations are requested, obtained, and entered into database accurately
  • Enter insurance changes & verification into database
  • Quality Assurance-quarterly audits (review files and conduct parent surveys)
  • Ensure that all statuses are up-to-date (active/inactive)
  • Periodic check of office data entry to ensure all cases are in good working order
  • Ensure new hires are onboarded timely and efficiently
  • Ensure provider compliance with the company as well as insurance companies
  • Research new insurances and complete all paperwork to join the network
  • Complete all monthly dashboards and reports
  • Other duties as assigned by manager


Requirements:

  • Bachelor’s degree in a related field or equivalent work experience.
  • Prior office experience a must
  • Strong Excel, Word and Outlook skills required
  • Strong written, verbal and presentation skills required
  • Excellent follow up skills & attention to detail
  • Ability to work both independently and as a team member
  • Strong relationship building skills
  • Ability to interact with all employee levels
  • Demonstrated strong leadership skills
  • Demonstrated adaptability and ability to manage change
  • Ability to multitask and respond quickly to concerns
  • Quick learner
  • Ability to work overtime when needed
  • Must be well organized and detail-oriented with ability to multi-task and adjust to changing concerns.
  • Able to take initiative & work independently when necessary
  • Solution focused and willing to drive issues to resolution with appropriate persistence and persuasiveness
  • Have a friendly disposition with the ability to establish and maintain effective working relationships with fellow co-workers, as well as providers and insurance representatives


Benefits Include:

  • Personal and Sick Time
  • Medical/dental/vision coverage
  • Paid Holidays
  • 401k with matching
  • Short-term, long-term disability, life insurance
  • Employee Recognition Events-and so much more!

*Please note that this role's location is a full-time in office position.

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This job description is subject to change at any time.
Achieve Beyond provides equal employment opportunities to all employees and applicants and prohibits discrimination and harassment of any type regarding race, color, religion, age, sex, national origin, disability status, genetics, caregiver status, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. If you are an individual with a disability requesting an accommodation for the application process, please contact us for assistance.