ABA Utilization Review Specialist

Spectrum Billing Solutions; Skokie (IL); Hybrid; USD 60,000 - 85,000; Full time

Benefits offered by this job

Flexible work environment

Competitive Salary

Close-knit team

Growth opportunities

Medical, Dental, Vision

Flexible Paid Time Off

401K with Company match

Supplemental Benefits

Job summary

Spectrum Billing Solutions is seeking an ABA Utilization Review Specialist. The role supports review of clinical data to determine medical necessity and manage authorizations for ABA and related services.

It is a fully remote or office/home hybrid position with a collaborative, detail-focused team. The candidate should have 3–5 years in utilization review, be proficient in insurance concepts, and possess strong written and verbal communication skills.

Qualifications

• 3-5 years of Utilization Review experience.
• ABA and/or Behavioral Health experience preferred.
• 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.

Responsibilities

• Review patient admission and clinical information to ensure medical necessity and compliance with utilization review guidelines.
• Obtain initial and continuing authorization for treatment services.
• Manage authorization denials including referral for peer review.
• Document and record all necessary information.
• Monitor and track new and ongoing authorization cases.
• Collaborate with clinical staff to obtain timely reviews.
• Assist external clients in understanding payer requirements for authorizations.
• Participate in team meetings.
• Maintain confidentiality of patient information and HIPAA compliance.

Skills

Utilization Review

ABA experience

Communication skills

Attention to detail

Independent worker

Multi-tasking

Insurance knowledge

Education

Bachelor's or Master's degree

Tools

Microsoft Excel

Billing software

Job description

About Spectrum Billing Solutions

Spectrum Billing Solutions offers industry-leading revenue cycle management services for healthcare providers. Our team has deep industry knowledge, technology, and experience to ensure our client's revenue cycle is managed in the most efficient and streamlined manner.

We are seeking a ABA Utilization Review Specialist

The ABA Utilization Review Specialist will utilize his or her knowledge and skills to review clinical information and obtain initial and continuing authorizations for ABA and related services. The ideal candidate is passionate, motivated, detail-oriented and interested in working in a cohesive and rewarding environment. This is a fully remote or office/home hybrid position.

Your Responsibilities:

• 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.


• 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 external clients in understanding payer requirements for authorizations.


• Participate in team meetings.


• Maintain confidentiality of patient information and adhere to HIPAA regulations.

What we offer you:

• Flexible work environment


• Competitive Salary


• A close-knit team of talented and skilled individuals.


• Growth opportunities


• Benefits - Medical, Dental, Vision


• Flexible Paid Time Off


• 401K with Company match


• Supplemental Benefits

Qualifications:

• 3-5 years of Utilization Review experience.


• ABA and/or Behavioral Healthexperiencepreferred.


• 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).

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