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Utilization Review Appeals Specialist Jobs

Appeals Specialist Jobs
By BlueCross BlueShield of South Carolina At Augusta, GA, United States
Excellent organizational, customer service, and written and verbal communication skills.
Proficiency in spelling, punctuation, and grammar skills.
Perform non-medical reviews and process redetermination letters ensuring timeliness and accuracy.
Prepare unit reports, analyze, and interpret workload, and process issues utilizing various software tools.
Update letters and documents within the department when necessary.
May gather and prepare documentation for legal inquiries and administrative requests.
Appeals Specialist Jobs
By BlueCross BlueShield of South Carolina At Columbia, SC, United States
Required Education: High School Diploma or equivalent
Required Work Experience: Two (2) years of job related experience (healthcare, insurance, banking or call center).
Our Comprehensive Benefits Package Includes
Eligible for up to a $2400 annual bonus.
Performs non-medical reviews and processes redetermination letters ensuring timeliness and accuracy.
Prepares unit reports, analyzes and interprets workload, and processes issues utilizing various software tools.
Behavioral Health Utilization Review Specialist
By County of Santa Cruz At ,
Invites you to apply for:
BEHAVIORAL HEALTH UTILIZATION REVIEW SPECIALIST
To view full job announcement:
Utilization Review Clinical Specialist (Remote)
By CHS Corporate At , Franklin, 37067

Computer Skills Required: Data entry skills; Demonstrable skills with Google Docs, Google Sheets, and email applications.

Utilization Review Specialist Jobs
By St. Charles Health System At , Bend, 97701 $24.32 - $33.44 an hour
Intermediate to advanced proficiency in Microsoft applications (Word, Excel and Access), database management, and document preparation
REPORTS TO POSITION: Manager, Utilization Review
Required: 2 years’ experience in similar hospital related position with utilization experience preferred
Strong team working and collaborative skills.
Strong analytical, problem solving and decision making skills.
DATE LAST REVIEWED: March 9, 2023
Appeals Specialist Jobs
By Kepro At Cary, NC, United States
Do you value care management and quality improvement?
Are you an experienced Appeals Specialist looking for a new challenge?
Excellent verbal and written communication skills.
Requires 3+ years’ customer service experience.
Previous experience in the health care industry preferred
Are you motivated, energetic, and excited to become part of the Kepro team?
Appeals & Support Specialist Jobs
By County of Dallas Tax Appraisal District At , Dallas, 75247 $32,000 - $49,653 a year
Previous customer service, appraisal office, or other office experience.
Bilingual in Spanish - (read and speak) is preferred.
Salary Range: $32,000 to $49,653 DOE
Rn Specialist Utilization Review
By HonorHealth At , Scottsdale, 85258
Determines qualifications for hospital level of care based on set criteria.
Initiates chart reviews, conducts follow-up reviews, and escalates secondary reviews to Physician Advisor as necessary.
Performs other duties as assigned.
Utilization Review Director Jobs
By Coastal Behavioral Health At , Savannah, 31406
Challenging and rewarding work environment
Excellent Medical, Dental, Vision and Prescription Drug Plan
401(K) with company match and discounted stock plan
Career development opportunities within UHS and its 300+ Subsidiaries
Utilization Review Business Support Specialist
By Allegheny Health Network At , Up to $30.93 an hour
Investigates concerns for improper billing/coding practices and recommends corrective action, works collaboratively to understand denial/appeal management process and alert edits/rejections. (10%)
Proficient with department software, analytical tools, basic coding and billing knowledge, and revenue cycle operational policies. (5%)
1 year experience with medical necessity appeals
Implements and organizes downgrades compliantly and per documentation. (10%)
Identifies trends with claim holds and denials and provides communication to all necessary parties. (10%)
Communicates with all parties in a professional manner to alert of specific problem issues. (10%)
Utilization Review Specialist Jobs
By Department of Behavioral Healt At , Washington, Dc $87,339 - $111,749 a year
Traffic record check (as applicable);
Consumer credit check (as applicable);
Reasonable suspicion drug and alcohol test; and
Post-accident or incident drug and alcohol test.
RESIDENCY PREFERENCE AMENDMENT ACT OF 1988
Bachelor’s Degree in Nursing preferred.
Utilization Review Specialist - Behavioral Health
By Prestige Utilization Management & Billing Solutions At , Remote $35,000 - $40,000 a year
Excellent data entry skills and ability to navigate electronic systems applicable to job functions
Ensure all pre-certifications are completed for inpatient and outpatient services
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.
Medicaid Utilization Review Analyst
By State of Idaho Employment At Greater Idaho Falls, United States
An opportunity for student loan forgiveness (https://studentaid.gov/manage-loans/forgiveness-cancellation/public-service)
an opportunity for student loan forgiveness (https://studentaid.gov/manage-loans/forgiveness-cancellation/public-service)
THIS ANNOUNCEMENT WILL BE OPEN UNTIL FILLED. APPLICANTS ARE ENCOURAGED TO APPLY AS SOON AS POSSIBLE TO BE CONSIDERED.
Generous vacation and sick leave accrual beginning as soon as you start
11 paid holidays a year
Multiple savings plans, optional 401K, and optional 457
Utilization Review Specialist(Ft)
By Cornerstone of Recovery At , Louisville, 37777, Tn
Notify supervisor when pre-certification is denied.
Develop collaborate relationships with third party payers and managed care companies
Continue education with new information regarding criteria for various insurance companies.
Track how particular Managed Care Companies approve residential days in keeping with progress notes under our ASAM criteria.
Average to above average computer skills.
Above average verbal and writing skills.
Utilization Review Business Support Specialist
By Allegheny Health Network At , , Pa
Investigates concerns for improper billing/coding practices and recommends corrective action, works collaboratively to understand denial/appeal management process and alert edits/rejections. (10%)
Proficient with department software, analytical tools, basic coding and billing knowledge, and revenue cycle operational policies. (5%)
1 year experience with medical necessity appeals
Implements and organizes downgrades compliantly and per documentation. (10%)
Identifies trends with claim holds and denials and provides communication to all necessary parties. (10%)
Communicates with all parties in a professional manner to alert of specific problem issues. (10%)
Utilization Review Specialist - Behavioral Health
By WellBridge Fort Worth At , Fort Worth, 76132, Tx
Coordinate utilization management reviews for all assigned inpatient, partial hospitalization and intensive outpatient program patients.
Coordinates closely with Director of Utilization Management, Nursing and Clinical Services.
Follows patients throughout the continuum of care and ensures optimum utilization of resources, service delivery and compliance with external review agencies.
Obtains authorizations for services, coordinates peer-to-peer reviews for assigned caseload.
Understands medical necessity criteria and facilitates accurate and timely documentation to support advocacy of services.
Master’s Degree in Social Work, Marriage and Family Therapy or Counseling from an accredited school or BSN, RN
Specialist, Appeals Jobs
By Experis At Columbia, SC, United States
Excellent organizational, customer service, and written and verbal communication skills.
Proficiency in spelling, punctuation, and grammar skills.
50% Performs non-medical reviews and processes redetermination letters ensuring timeliness and accuracy.
30% Prepares unit reports, analyzes, and interprets workload, and processes issues utilizing various software tools.
10% Updates letters and documents within the department when necessary.
10% May gather and prepare documentation for legal inquiries and administrative requests.
Utilization Review Specialist Jobs
By MTR TREATMENT CORP At United States
Function as a member of the Billing Team to ensure that all daily responsibilities are met.
Aid in verification of benefits when needed.
Excellent verbal and written communication skills.
Prior Utilization Review experience in a Substance abuse environment.
Knowledge of ASAM and medical necessity guidelines as it relates to substance abuse.
The Utilization Review Specialist will perform pre-certification reviews, concurrent reviews and discharge reviews for substance abuse facilities.
Utilization Review Specialist Jobs
By Within Health At Houston, TX, United States
MUST HAVE EXPERIENCE WITH EATING DISORDER CLIENTS*
Complete precertification process and associated documentation.
Manages time effectively, setting priorities, and consistently meeting deadlines.
Excellent verbal and written communication skills.
Maintain efficient methods for ensuring the medical necessity and appropriateness of prescribed level of care.
Oversee the entire UR process for client journey from admission to discharge.
Aba Utilization Review (Ur) Specialist
By Spectrum Billing Solutions At Skokie, IL, United States
Manage authorization denials including referral for peer review.
Assist the treatment team in understanding payer requirements for admission, continued stay and discharge planning.
3-5 years of related ABA, Substance Abuse, and/or Mental Health experience.
Superior written and oral communication skills
Solid understanding of insurance benefits and coverages.
Strong computer skills (Word, Excel, billing software).

Are you looking for an exciting new challenge in the healthcare industry? We are looking for a motivated and experienced Utilization Review Appeals Specialist to join our team. You will be responsible for reviewing and resolving appeals for medical services, ensuring that all appeals are handled in a timely and accurate manner. If you have excellent communication and problem-solving skills, and a passion for helping people, this could be the perfect job for you!

Overview:

A Utilization Review Appeals Specialist is responsible for ensuring that health care services are provided in accordance with established standards and regulations. They review appeals from providers and patients regarding denied services and make decisions based on the evidence presented. They also provide guidance to providers and patients on the appeals process and ensure that all appeals are handled in a timely manner.

Detailed Job Description:

Utilization Review Appeals Specialists are responsible for reviewing appeals from providers and patients regarding denied services. They must review the evidence presented and make decisions based on the evidence. They must also provide guidance to providers and patients on the appeals process and ensure that all appeals are handled in a timely manner. They must also ensure that health care services are provided in accordance with established standards and regulations.

What is Utilization Review Appeals Specialist Job Skills Required?

• Excellent communication and interpersonal skills
• Strong analytical and problem-solving skills
• Ability to work independently and as part of a team
• Knowledge of health care regulations and standards
• Ability to make decisions based on evidence
• Knowledge of the appeals process

What is Utilization Review Appeals Specialist Job Qualifications?

• Bachelor’s degree in health care administration, business administration, or a related field
• At least two years of experience in utilization review or appeals
• Knowledge of health care regulations and standards
• Ability to make decisions based on evidence
• Excellent communication and interpersonal skills

What is Utilization Review Appeals Specialist Job Knowledge?

• Knowledge of health care regulations and standards
• Knowledge of the appeals process
• Knowledge of medical terminology
• Knowledge of medical coding

What is Utilization Review Appeals Specialist Job Experience?

• At least two years of experience in utilization review or appeals
• Experience in health care administration, business administration, or a related field

What is Utilization Review Appeals Specialist Job Responsibilities?

• Review appeals from providers and patients regarding denied services
• Provide guidance to providers and patients on the appeals process
• Ensure that all appeals are handled in a timely manner
• Ensure that health care services are provided in accordance with established standards and regulations
• Make decisions based on the evidence presented