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Utilization Review Specialist - Remote

Posted 5 weeks ago
All others
Full Time
Worldwide

Overview

Spectrum Billing Solutions is an industry-leading revenue cycle management company for healthcare organizations. We are looking to add a Utilization Review (UR) Specialist to our growing team. The UR Specialist will utilize his or her knowledge and skills to review clinical information and obtain initial and continuing authorizations for behavioral healthcare services. The ideal candidate is passionate, motivated, detail-oriented, and interested in working in a cohesive and rewarding environment.

In Short

  • Review patient admission and clinical information to ensure medical necessity and compliance of utilization review guidelines.
  • Obtain initial and continuing authorization for treatment services.
  • Manage authorization denials including referral for peer review.
  • Demonstrate the ability to make critical decisions about medical necessity of treatment by using good judgment.
  • Advocate on behalf of patients to ensure maximum length of stay at the appropriate level of care.
  • Interact with insurance companies in a respectful, professional manner that facilitates the utilization review process and follows policies and procedures.
  • Document and record all necessary information.
  • Monitor and track new and ongoing authorization cases.
  • Collaborate and communicate with clinical staff to ensure necessary information is obtained and timely reviews are performed.
  • Assist the treatment team in understanding payer requirements for admission, continued stay and discharge planning.
  • Participate in team meetings and case conference reviews.
  • Perform other duties as assigned.
  • Maintain confidentiality of patient information and adhere to HIPAA regulations.

Requirements

  • 3-5 years of related ABA, Substance Abuse, and/or Mental Health experience.
  • Bachelor’s or master’s degree preferred.
  • Superior written and oral communication skills.
  • Attention to detail to ensure necessary information is captured and properly documented.
  • Ability to work independently and within a team.
  • Ability to multi-task, prioritize and meet expected deadlines.
  • Solid understanding of insurance benefits and coverages.
  • Strong computer skills (Word, Excel, billing software).
  • Understanding of mental and behavioral health treatment services.

Benefits

  • A close-knit team of talented and skilled individuals.
  • Growth opportunities within the organization.
  • Competitive salary.
  • Healthcare benefits including 401K, medical, dental & vision.
  • Flexible PTO.
Spectrum Billing Solutions logo

Spectrum Billing Solutions

Spectrum Billing Solutions is a leading revenue cycle management company specializing in healthcare organizations. The company is dedicated to providing exceptional services in utilization review, ensuring that patients receive the necessary authorizations for behavioral healthcare services. With a focus on a cohesive and rewarding work environment, Spectrum Billing Solutions values detail-oriented and motivated individuals who are passionate about making a difference in the healthcare industry. The company offers flexible work arrangements, growth opportunities, and a supportive team atmosphere.

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