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Utilization Review Specialist - Behavioral Health

Company

Prestige Utilization Management & Billing Solutions
Address , Remote
Employment type FULL_TIME
Salary $35,000 - $40,000 a year
Expires 2023-10-06
Posted at 9 months ago
Job Description

Utilization Review team members advocate on behalf of patients to managed care providers for necessary treatment.

Description

  • Actively Communicate with interdisciplinary team members to acquire information and give updates on authorizations
  • Interface with managed care organizations, external reviews, and other payers
  • Work with facilities to ensure documentation requirements are met
  • As a Utilization Review Specialist, you will accurately and timely complete utilization review activities
  • Ensure all pre-certifications are completed for inpatient and outpatient services
  • Monitor level of care LOS, report appropriately

Qualifications
  • 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.
  • Advanced Computer Skills (mac platforms, word, excel, etc)
  • Excellent data entry skills and ability to navigate electronic systems applicable to job functions
  • Strong Organization skills and dedication to continuous learning in the field.
  • Knowledge of mental health and chemical dependency terminology, symptoms, diagnoses, and treatment
  • Knowledge of HIPAA Guidelines and federal substance abuse treatment confidentiality guidelines
  • Able to pass a Background Clearance
  • 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
  • Ability to communicate effectively with patients, internal and external treatment providers, and managed care clinical review care managers
  • Familiar with ICD-9 codes, billing codes, DSM VI TR diagnostic codes
  • Ability to prioritize, multi-task, and meet strict deadlines.

Responsibilities
  • Verification of Insurance Benefits
  • Verification of correct information in an electronic health record
  • Release of clinical/medical records to appropriate agencies and requests
  • Knowledge of billing documentation
  • Speaking with Clients/Financial Responsible Parties

Benefits (Full Time)
  • Dental insurance
  • Vision insurance
  • Health insurance
  • Paid time off

Salary

$35,000 - $40,000 per year