Utilization Review Specialist

Sunshine Behavioral Health Group; Washington; On-site; USD 55,000 - 65,000; Full time

Job summary

Sunshine Behavioral Health is seeking a Utilization Review Coordinator in Washington state. The role focuses on communicating clinical information to managed care and payer services to obtain authorizations for treatment.

The candidate should have UR experience, knowledge of medical terminology and HIPAA, with proficiency in Excel and Word. Strong organization, communication, and ability to work with minimal supervision are essential.

Qualifications

• Minimum of two years of experience in Utilization Review.
• Proficiency with Excel, Word and electronic charting.
• Valid Driver’s License.

Responsibilities

• Complete assessments and pre-certifications for clients.
• Communicate required information to staff promptly.
• Demonstrate understanding of medical terminology.
• Explain policy deductibles, co-pays, co-insurance and out-of-pocket maximums.
• Interpret EOBs.
• Daily use of ten-key, data entry and spreadsheets.
• Coordinate with peers and supervisor on billing and claims.
• Follow HIPAA, compliance and confidentiality standards.
• Participate in Quality Improvement projects.
• Follow company policies and procedures.
• Attend staff meetings and trainings.
• Demonstrate expertise in psychiatric and addiction disorders.
• Communicate with families and insurers professionally.
• Work with Excel, Word and electronic charting.
• Able to work with minimal supervision.
• Be organized and detail oriented.
• Other duties as assigned.

Skills

Ability to work with minimal supervise

Organizational skills

Communication skills

Tools

Excel

Word

Electronic charting

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Full Time WA, US

3 days ago Requisition ID: 1338

Salary Range: $55,000.00 To $65,000.00 Annually

POSITION SUMMARY:

The Utilization Review Coordinator is responsible for communicating substance abuse and mental health clinical information to managed care/insurance companies and payer services to obtain authorization for treatment services provided by Sunshine Behavioral Health. The Utilization Review Coordinator must be familiar with admissions pre-certification process as well as concurrent and discharge reviews. Extensive knowledge of medical terminology, substance abuse and mental health disorders, ASAM criteria and ICD-10 diagnosis codes is necessary.

MAJOR DUTIES AND RESPONSIBILITIES:

• Complete assessments and pre-certifications for clients.
• Communicate necessary information received toappropriate staffina timelyand efficientmatter.
• Demonstrate understanding of medical terminology.
• Demonstrate understanding of policy deductibles, co-pays, co-insurance and out of pocket maximums, out of network deductions and exclusions.
• Demonstrate knowledge of EOB interpretation.
• Daily use of ten key, dataentryand spreadsheets applications.
• Communicate effectively with peers andsupervisorto address billing and claim issues.
• Follow all HIPAA, compliance,privacyand confidentiality standards.
• Participate indevelopmentof Quality Improvement projects.
• Follow all practices detailed inthe companiesPolicies and Procedures Manual and Employee Handbook.
• Attend andparticipatein staff meetings andtrainings.
• Demonstrateexpertisein Psychiatric and Addiction Disorders.
• Engage inappropriate writtenand verbal communication with families, insurance companies and otherprofessional.
• Demonstrateabilityto work with Excel,Wordand electronic chanting.
• Ability to work with minimal supervision.
• Organized and detail oriented.
• Other dutiesas assigned.

ESSENTIAL KNOWLEDGE, SKILLS, AND ABILITIES:

Knowledge: The UR Coordinator will:

• Possessproficiencyin Excel,Wordand electronic charting.
• Demonstrateabilityto work with minimal supervision.
• Basic knowledge of HIPAA.
• Demonstrateabilityto work under pressure.

Abilities: To excel in this position the incumbent should be able to demonstrate the following competencies:

• Problem Solving- The UR Coordinatorwill be able toidentifyand resolve problems in efficient and effective ways.
• Ethics - Treat clients, staff, co-workers, visitors, contractors, and guests of Sunshine Behavioral Health with respect and dignity; work ethically and uphold the values and standards or Sunshine Behavioral Health.
• Attendance, Punctuality, Reliability - Arrive on-site, on-time, as scheduled, consistently with a professional disposition. Ensure all work responsibilities are covered in the event of an absence or scheduled vacation.
• Leadership - Constant development of staff, co-workers and clients, effort to achieve each individual's highest potential.
• Strong Character - Staying calm under pressure is essential. Having an approachable demeanor without compromising Sunshine Behavioral Health Standards of ethics and workmanship.
• Flexibility- Openness to different and new ways of doing things; willingness to modify one's preferred way of doing things.
• Organization - Must be highly organized and efficient in managing the necessary daily client/staff demands and tasks associated with them.

QUALIFICATIONS AND PREFERENCES:

• A minimum of twoyearof experience with Utilization Review.
• Valid Driver’s License.

Sunshine Behavioral Health is an equal opportunity employer and prohibits discrimination and harassment of any kind.