Healthcare Utilization & Reimbursement Specialist

Harboroaks; Valdosta (GA); On-site; USD 45,000 - 65,000; Full time

Job summary

Harboroaks in Valdosta, Georgia, is seeking a dedicated professional to monitor patient service utilization, ensuring optimal reimbursement for the facility. The role involves collaboration with managed care organizations and providing training to staff.

Candidates should have a high school diploma, with preference given to those holding a degree in Social Work or a related field. Clinical experience and relevant certifications are essential for candidates.

Qualifications

• Clinical experience required; or 2+ years' experience with the facility's population.
• Preferred licensure includes LPN, RN, LMSW, LCSW, LPC.
• Strong communication skills are essential.

Responsibilities

• Monitor utilization of services for patients to optimize reimbursement.
• Liaison between managed care organizations and facility staff.
• Conduct quality reviews for medical necessity.

Skills

Clinical experience

Utilization management

Communication skills

Education

High school diploma or equivalent

Associate's, Bachelor's, or Master’s degree in a related health field

Tools

CPR certification

First aid certification

Job description

Harboroaks in Valdosta, Georgia, is seeking a dedicated professional to monitor patient service utilization, ensuring optimal reimbursement for the facility. The role involves collaboration with managed care organizations and providing training to staff.

Candidates should have a high school diploma, with preference given to those holding a degree in Social Work or a related field. Clinical experience and relevant certifications are essential for candidates.