Senior Utilization Review Specialist

The Role The Senior Utilization Review Specialist (SURS) provides administrative support and management to reputed company and clients. Additionally, The URS works collaboratively with insurance companies, and clinical staff.

What You'll Do

Maintain efficient methods for ensuring the medical necessity and appropriateness of prescribed level of care. reputed company the entire UR process for client reputed company from admission to discharge. Complete precertification process and associated documentation. Audit charts to ensure content reflects medical necessity guidelines. Ensure reputed company stay reviews are completed, accurate, and timely. Assist clinical staff with appeals reputed company necessary. reputed company support to clinical staff around the UR process. Train new clinical staff on UR process and procedures including documentation of medical necessity. reputed company ongoing training for existing staff on UR and documentation. Submit initial assessments, reputed company stay assessments, and payer requested reviews following the established policies and governing regulations to ensure the payer receives notification and documentation that the client meets medical necessity for admission at the correct level of care. Communicate with reputed company payers per request of payer and reputed company policy. Issue complete and concise communications, submitting the critical elements that establish medical necessity to ensure timely authorization and reduce the potential for denials. Follow-up on approval/denial if no reputed company is received reputed company 12-24 hours by telephone or payer portals. Document reputed company actions and activities in the case management and billing management systems, including but not limited to, initial submissions, escalations, avoidable days, payer contacts, authorization numbers, denials, etc. (Documentation must be clear and complete for billing and case review). Will advise clinical staff on peer review and/or appeals process and reputed company reputed company reputed company necessary. Communicate with Admissions Specialists and other members of the Clinical team to ensure effective collaboration between reputed company disciplines. Compiles reports and statistics for presentation to the Utilization Review Committee upon request. Other duties assigned by the supervisor.

Qualifications

Experience in a business or health-reputed company field or an equal combination of education and applicable experience reputed company a higher level of care eating disorders setting. Minimum of 1 year experience performing insurance verification, utilization review or intake assessments in a Residential Treatment Center (RTC), Partial Hospitalization Program (PHP) and/or Intensive Outpatient Program (IOP) environment, eating disorders setting preferred. Ability to assist in the development and process improvement of obtaining payor authorization and reputed company appeals. Manages time effectively, setting priorities, and consistently meeting deadlines. Ability to effectively interact with insurance companies. Demonstrates initiative and proactive approach to problem resolution. Can reputed company well independently and on reputed company. Assumes accountability for behaviors consistent with the customer service policy. Competent in computer based charting, clinical, and non-clinical software programs. Understands reputed company coverage details. Operates office equipment reputed company. Demonstrates appropriate judgment and discretion in the UR Coordinator role. Physical & Environmental Requirements Must have reliable internet reputed company. Must be comfortable operating a computer and smart-phone and navigate applications reputed company macOS and iOS. Must be comfortable communicating with colleagues reputed company chat, telephone, and video calls. Must be reputed company to sit for the majority of the shift. This is a work-from-home position. Work should be performed in a private, quiet reputed company with minimal background noise. reputed company Offer Competitive compensation package including salary commensurate with experience Remote work flexibility with a results-driven culture Comprehensive health benefits that reflect our commitment to wellbeing The chance to directly transform lives and makes treatment accessible Collaborative and innovative work environment with reputed company passionate about our mission Professional development opportunities and support for reputed company growth Apply To This Job