Healthcare Utilization & Authorization Specialist

Advantage Behavioral Health; Marlton (NJ); On-site; USD 55,000 - 70,000; Full time

Job summary

Advantage Behavioral Health in Marlton, NJ is seeking an Utilization Review Specialist to process insurance authorizations for partial hospitalization, intensive outpatient, and outpatient programs across ABHS entities.

You will collaborate with Patient Access, Billing, Clinical and Medical teams; review medical records for medical necessity; manage denials appeals; and outreach to insurers to obtain timely approvals.

Qualifications

• 1 year of Utilization Review experience.
• Experience with electronic medical records systems.
• Computer literate: Microsoft Office (Excel, Word, PowerPoint).

Responsibilities

• Handle the continuum of the utilization process for ABHS entities.
• Outreach to insurers to gain authorizations for services including TMS and outpatient programs.
• Maintain communication with Patient Access, Billing, Clinical and Medical departments.
• Evaluate medical information for medical necessity.
• Administer appeal process for denials.
• Assist and cover other staff to maintain productivity.

Skills

Adaptability

Customer Service

Interpersonal Skills

Organization Skills

Decision Making

Teamwork

Education

High School Diploma or equivalent education

Tools

Microsoft Office

Electronic Health Records

Job description

Advantage Behavioral Health in Marlton, NJ is seeking an Utilization Review Specialist to process insurance authorizations for partial hospitalization, intensive outpatient, and outpatient programs across ABHS entities.

You will collaborate with Patient Access, Billing, Clinical and Medical teams; review medical records for medical necessity; manage denials appeals; and outreach to insurers to obtain timely approvals.