Utilization Review & Authorization Specialist

Paylocity; Billings (MT); On-site; USD 42,000 - 64,000; Full time

Job summary

Rimrock is seeking a Utilization Review Coordinator to manage the administrative components of utilization review across all levels of care and payers. You will coordinate authorizations from admission through discharge, request clinical documentation, and ensure timely submissions while collaborating with billing and clinical leadership.

This non-clinical role does not determine medical necessity but ensures documentation and submissions meet payer requirements and HIPAA/42 CFR Part 2

Qualifications

• High school diploma or equivalent required; associate degree in health information management, medical billing, business, or a related field preferred.
• Minimum of two years' experience in healthcare billing, prior authorizations, insurance verification, medical records, or a medical office setting.
• Experience in behavioral health or substance use disorder treatment, and familiarity with Montana Medicaid, ASAM levels of care, and BHDD Medicaid Services Provider Manual preferred.
• Certification such as CPB, CRCS, or RHIT preferred.

Responsibilities

• Maintains the UR tracker as the single record of every authorization across Medicaid and commercial payers.
• Monitors authorization end dates and calendars all required deadlines.
• Verifies payer eligibility and authorization requirements at admission.
• Requests clinical documentation from clinical staff with clear due dates.
• Submits authorization requests through payer portals, including Montana Medicaid portal, and by fax/telephone.
• Prepares and files written requests for reconsideration, including peer-to-peer and desk reviews.
• At discharge, reconciles final authorized dates and notifies billing of any unauthorized days.
• Logs determinations, requests for information, and denials; routes requests for information.

Skills

Organization

Deadline management

Communication

Attention to detail

Records management

EHR proficiency

Education

High school diploma or equivalent

Associate degree in health information management, medical billing, business, or related field

Job description

Rimrock is seeking a Utilization Review Coordinator to manage the administrative components of utilization review across all levels of care and payers. You will coordinate authorizations from admission through discharge, request clinical documentation, and ensure timely submissions while collaborating with billing and clinical leadership.

This non-clinical role does not determine medical necessity but ensures documentation and submissions meet payer requirements and HIPAA/42 CFR Part 2