JOB DESCRIPTION

Utilization Review Specialist

Reports to: Utilization Review Director

JOB SUMMARY
Under the direction of the Utilization Review Director (URD), the Utilization Specialist acts as a
liaison with a patient’s insurance company, coordinates billing, payments, authorizations with
insurance companies, and monitors authorizations.
QUALIFICATIONS
Required:

  • High School Diploma/Equivalent
  • Current CPR Certification
  • Valid Driver’s License
  • Proficiency in Microsoft Office Suite, including Word, Excel
  • 5 years’ working experience or a minimum of Bachelor’s Degree in Social Work/Psychology or other related field
  • Preferred:
  • 1 year experience working in a residential/behavioral healthcare setting.
  • Experience working with insurance companies.
  • Master’s level degree and licensure in social work.

JOB DUTIES AND RESPONSIBILITIES

  • Act as an advocate and liaison with client’s insurance to coordinate authorization for
    treatment.
  • Managing patient authorizations for treatment.
  • Coordinate with clients, treatment team members and billing department routinely to
    ensure timely and necessary communications to obtain authorizations and claims
    payment from payers.
  • Complete initial pre-cert requests with new admits as well as manage ongoing concurrent
    reviews for continued authorizations from payers.
  • Auditing and submitting requested medical records for claims
  • Maintain all spreadsheets and data sources to track authorizations and data.
  • Maintain organization and filing of all patient financial records.
  • All other duties as assigned.

KNOWLEDGE, SKILLS, AND ABILITIES

  • Ability to communicate effectively both verbally and in writing.
  • Computer literacy and proficiency in the use of Microsoft Office software.
  • Knowledge of medical and behavioral health terminology
  • Knowledge in reviewing medical and behavioral health records for medical necessity
  • Skill in operating a personal computer and utilizing a variety of software applications,
    printers and fax machine.
  • Ability to apply UR Guidelines and processes consistently
  • Knowledge of the current version of the Diagnostic Statistical Manual of Mental Disorders (DSM)

Apply Here:

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