ABA Utilization Review (UR) Specialist

Spectrum Billing Solutions; Skokie (IL); On-site; USD 70,000 - 95,000; Full time

Benefits offered by this job

Flexible work environment

Competitive Salary

Growth opportunities

Benefits – 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 to review clinical information and obtain authorizations for ABA and related services. This role supports remote or office/home hybrid work and emphasizes attention to medical necessity and HIPAA compliance.

The ideal candidate has 3-5 years of ABA/Behavioral Health experience, strong communication skills, and the ability to multi-task while meeting deadlines in a collaborative team setting.

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.

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.

Skills

ABA/Behavioral Health experience

Written and spoken communication

Attention to detail

Independent and team work

Multi-tasking & priority setting

Education

Bachelor’s or Master’s degree preferred

Tools

Word

Excel

Billing software

Job description

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.

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 related ABA and/or Behavioral Healthexperience.
• 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.

Utilization Review Specialist | Utilization Management Specialist | UR Specialist | Revenue Cycle Specialist | Insurance Specialist | UR Specialist | Revenue Cycle Utilization Review Specialist | ABA Utilization Review Specialist | ABA Utilization Management Specialist | ABA UR Specialist | Behavioral Health Billing Specialist

#UtilizationReviewSpecialist | #UtilizationManagementSpecialist | #URSpecialist | #RevenueCycleSpecialist | #InsuranceSpecialist | #URSpecialist | #RevenueCycleUtilizationReviewSpecialist | #ABAUtilizationReviewSpecialist | #ABAUtilizationManagementSpecialist | #ABAURSpecialist | #BehavioralHealthBillingSpecialist