Utilization Review Coordinator (UR Coordinator)

Compassion Behavioral Health; Boynton Beach (FL); On-site; USD 50,000 - 75,000; Full time

Job summary

Compassion Behavioral Health in Boynton Beach, FL is seeking a Utilization Review Coordinator to manage concurrent reviews across locations, handle insurance authorizations, and oversee the appeals process.

The role requires 4+ years in utilization review within behavioral health, strong communication skills, and proficiency with MS Excel. This on-site position reports to the Director of Utilization Review and operates Monday–Friday.

Qualifications

• 4+ years in a utilization review capacity or equivalent experience in behavioral health.
• Understanding of the utilization review process and prior patient care or related work in behavioral health.
• Experience as a reviewer/appeals specialist or related support roles in treatment facilities is desirable.
• Strong computer skills with MS Office, especially Excel.
• Strong written and verbal communication skills are essential.
• College degree preferred but not required.
• Medical/clinical background preferred but not required.

Responsibilities

• CLINICAL DATA REVIEW – Review clinical data to understand patient history and medical necessity for admission/continuation.
• INSURANCE REVIEW CALLS – Communicate clinical information to insurers to obtain authorization for treatment.
• APPEALS ADVOCACY – Communicate relevant clinical information to overturn denials and advocate for coverage.

Skills

Communication skills

Problem solving

Education

Bachelor's degree preferred

Tools

MS Excel

MS Office

Job description

Position Purpose

The Utilization Review Coordinator (UR Coordinator) is responsible to perform the process of utilization review to ensure appropriate reimbursement by third party payers. This includes managing concurrent reviews for multiple locations and levels of care, the denial/appeals process, as well as the flow, organization, and reporting of information.

Responsibilities

This position reports to our Director of Utilization Review and will contribute to our overall efforts through the following responsibilities:

• CLINICAL DATA REVIEW – Review clinical data, including medical records, patient charts and provider notes to understand patient history and to gain solid understanding of individual patient circumstances, needs and medical necessity for purposes of admission and or continued stay advocacy.
• INSURANCE REVIEW CALLS – Communicate clinical information to insurance companies to obtain authorization to treat and or to facilitate continued stay. Utilize knowledge of billing process and clinical data to present viable arguments for insurance coverage.
• APPEALS ADVOCACY – Speak with clinicians at insurance company upon denial of coverage to communicate relevant clinical information and bring light to individualized patient issues that necessitate coverage for prior treatment. Utilize facts to communicate in knowledgeable, persistent, passionate and or creative manner to achieve desired results for client base.

Work Schedule

Monday through Friday from 9:00am to 5:00pm. This is not a remote position.

Qualifications

• 4 + years prior experience in a utilization review capacity or equivalent experience. Must demonstrate prior experience, knowledge of insurance industry, and or aptitude for effective claim advocacy.
• Understanding of the Utilization review process, prior patient care or related work experience in the substance abuse, behavioral and or mental health treatment field required.
• Prior experience as a behavioral health technician, verification specialist or appeals specialist and/or other support staff in treatment facilities is highly desirable.
• Strong computer skills and knowledge of MS Office products, including skills in MS Excel required. Ability to quickly navigate between platforms necessary.
• Strong written and verbal communication skills are a must have.
• College degree preferred but not required.
• Medical and or clinical background/education is preferred but not required.