Behavioral Health Utilization Specialist

Tcn Behavioral Health Services Inc; Xenia (OH); On-site; USD 55,000 - 75,000; Full time

Job summary

TCN Behavioral Health Services Inc. in Xenia, OH is seeking a Behavioral Health Utilization Analyst to manage prior authorizations, utilization management, data tracking, and reporting for mental health and substance use services.

The role requires reviewing clinical documentation for medical necessity, coordinating with clinical staff and payers, and maintaining accurate authorization records while ensuring HIPAA compliance.

Qualifications

• Education: Associate degree required; bachelor’s preferred in related field.
• Experience with Medicaid or payer portals is preferred.
• Strong attention to detail and ability to manage multiple deadlines.
• Experience creating reports and maintaining tracking systems.
• Experience with electronic health records and SQL-based reporting preferred.

Responsibilities

• Completes and submits prior authorization and related requests for behavioral health services.
• Reviews clinical documentation to determine medical necessity and payer requirements.
• Maintains centralized tracking of authorization data, units, and timelines.
• Assists staff with documentation, workflow, and reporting needs related to authorizations.
• Submits information through payer portals, fax, email, or other required methods.
• Responds to payer requests and communicates decisions to appropriate staff.
• Supports QA activities, trend analysis, and process improvement in utilization management.
• Collaborates with clinical, billing, MIS, and leadership to optimize reporting and workflow.

Skills

Behavioral health

Utilization management

Prior authorization

Billing

Case management

Clinical documentation review

Data management

Reporting

Education

Associate degree required

Bachelor’s degree in healthcare administration or related field preferred

Tools

Electronic Health Records

SQL-based reporting

Dashboards

Report-writing software

Job description

TCN Behavioral Health Services Inc. in Xenia, OH is seeking a Behavioral Health Utilization Analyst to manage prior authorizations, utilization management, data tracking, and reporting for mental health and substance use services.

The role requires reviewing clinical documentation for medical necessity, coordinating with clinical staff and payers, and maintaining accurate authorization records while ensuring HIPAA compliance.