Billing & Utilization Review Specialist

Apploi; Nashville (TN); On-site; USD 52,000 - 64,000; Full time

Job summary

Apploi in Nashville is seeking an Utilization Review and Support Specialist to work with leadership and clinical staff to manage precertification and concurrent reviews, insurance billing, and reporting.

Responsibilities include auditing records, compiling monthly statistics, and ensuring compliance with TNWITS and insurer requirements; the role supports admissions and clinical teams daily.

Qualifications

• Minimum two years of college or associate degree in a human service-related field or LADAC eligible.
• Minimum two years of experience in substance abuse treatment admissions/medical records.
• Experience conducting insurance precertification and continued stay reviews.
• Experience with client assessments and billing.

Responsibilities

• Verify insurance coverage and benefits according to ASAM/agency criteria.
• Perform precertification and concurrent reviews for residential and intensive outpatient programs.
• Submit insurance billing to managed care organizations and monitor payments/denials.
• Submit required documentation to MCOs and assist with scheduling TNCare discharge appointments.
• Attend payer meetings and report updates to leadership.
• Balance TNWITS encounters weekly and reconcile SRC database monthly.
• Conduct Level I record audits and interview clients for pre-screening.
• Prepare utilization management and statistical reports for the PSO.
• Participate in Professional Staff Organization meetings.

Skills

Substance abuse treatment admissions

Medical records

Insurance precertification

Continued stay reviews

Client assessments

Billing

Education

Associates degree or two-year college in human services

Job description

Apploi in Nashville is seeking an Utilization Review and Support Specialist to work with leadership and clinical staff to manage precertification and concurrent reviews, insurance billing, and reporting.

Responsibilities include auditing records, compiling monthly statistics, and ensuring compliance with TNWITS and insurer requirements; the role supports admissions and clinical teams daily.