ABA Utilization Review (UR) Specialist

Spectrum Billing Solutions; Skokie (IL); Hybrid; USD 60,000 - 80,000; Full time

Benefits offered by this job

Flexible work environment

Medical, Dental, Vision benefits

401K with company match

Flexible Paid Time Off

Job summary

Spectrum Billing Solutions is seeking an ABA Utilization Review (UR) Specialist to join their team. This fully remote or hybrid position involves reviewing clinical information and obtaining authorizations for ABA services. Candidates should have 3-5 years of relevant experience and strong communication skills. The role offers a supportive team environment and competitive salary, along with benefits including healthcare and 401K.

Join us to contribute to optimizing healthcare provider revenue cycles in a rewarding setting.

Qualifications

• 3-5 years of related ABA and/or Behavioral Health experience.
• Superior written and oral communication skills.
• Ability to work independently and within a team.

Responsibilities

• Review patient admission and clinical information to ensure medical necessity.
• Obtain initial and continuing authorization for treatment services.
• Manage authorization denials and collaborate with clinical staff.

Skills

Attention to detail

Strong computer skills

Communication skills

Multi-tasking

Understanding of insurance benefits

Education

Bachelor's or master's degree

Job description

Overview

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 to add an ABA Utilization Review (UR) Specialist to our growing team. The ABA UR 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.

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 related ABA and/or Behavioral 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.