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Utilization Review Specialist

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, printer 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 online through our website: https://brightonrecoverycenter.com/careers/ OR email a copy of your resume to Chloe Swanson, HR Specialist, at cswanson@brightonrecoverycenter.com.

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Last Updated: 2/24/22