Utilization Review team members advocate on behalf of patients to managed care providers for necessary treatment.
•As a Utilization Review Specialist, you will accurately and timely complete utilization review activities
•Actively Communicate with interdisciplinary team members to acquire information and give updates on authorizations
•Ensure all pre-certifications are completed for inpatient and outpatient services
•Monitor level of care LOS, report appropriately
•Work with facilities to ensure documentation requirements are met
•Interface with managed care organizations, external reviews, and other payers
•2 or more years experience billing UR healthcare industry – in the mental health/addiction field.
•Working knowledge of clinical case formulation for substance abuse/mental health treatment.
•Knowledge of mental health and chemical dependency terminology, symptoms, diagnoses, and treatment
•Familiar with ICD-9 codes, billing codes, DSM VI TR diagnostic codes
•Ability to prioritize, multi-task, and meet strict deadlines.
•Strong Organization skills and dedication to continuous learning in the field.
•Able to pass a Background Clearance
•Advanced Computer Skills (mac platforms, word, excel, etc)
•Excellent data entry skills and ability to navigate electronic systems applicable to job functions
•Knowledge of HIPAA Guidelines and federal substance abuse treatment confidentiality guidelines
•Ability to communicate effectively with patients, internal and external treatment providers, and managed care clinical review care managers
•Ability to multi-task, pay attention to detail, problem solve, utilize critical thinking skills, prioritize, and work both independently and as a part of a team
•Verification of Insurance Benefits
•Speaking with Clients/Financial Responsible Parties
•Knowledge of billing documentation
•Release of clinical/medical records to appropriate agencies and requests
•Verification of correct information in an electronic health record
Benefits (Full Time)
•Paid time off
$15 - $20 per hour