On-Site Utilization Review Specialist

Pioneer Human Services; Spokane (WA); On-site; USD 27,000 - 34,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Flexible Spending Account (FSA)

Dependent Care FSA

Life insurance

AD&D insurance

Disability coverage

Front-Loaded Tuition Assistance

Retirement Plan

Employee recognition programs

Public transportation discounts

Employee Assistance Program (EAP)

Job summary

Pioneer Human Services is seeking an Utilization Review Administrator to help control costs, improve revenue collection, and ensure data integrity on-site in Spokane, WA. You will review medical records for accuracy to secure timely payments and work with clinical, leadership and administrative staff.

The role requires 1 year in behavioral health settings and 1 year of related experience, with a focus on pre-authorization and billing processes.

Qualifications

• High school diploma or GED required.
• At least 1 year of experience in substance use, medical, or mental health fields.
• At least 1 year of experience working with individuals with behavioral health conditions.
• Preferred: Associate degree in health care, business, or related field.
• Preferred: 1 year administrative experience in healthcare or related field.
• Preferred: experience in a residential treatment facility.

Responsibilities

• Monitor utilization patterns and notify leadership of issues.
• Review bed boards daily for accuracy.
• Ensure initial authorizations, episodes, and bed boards are timely.
• Analyze required reports and maintain UR documentation.
• Conduct peer-to-peer review with MCO to appeal denials.
• Submit appeals for denied authorizations with required info.
• Coordinate revenue cycle tasks for funding and non-clinical issues.
• Collaborate with billing, clinical, and finance teams to ensure data accuracy.

Skills

Detail oriented

Communication

Teamwork

Education

High school diploma/GED

Associate degree in health care or related field

Job description

Pioneer Human Services is seeking an Utilization Review Administrator to help control costs, improve revenue collection, and ensure data integrity on-site in Spokane, WA. You will review medical records for accuracy to secure timely payments and work with clinical, leadership and administrative staff.

The role requires 1 year in behavioral health settings and 1 year of related experience, with a focus on pre-authorization and billing processes.