Utilization Review Specialist

Charles River Recovery LLC.; Weston (MA); On-site; USD 33,000 - 36,000; Part time

Job summary

Charles River Recovery LLC. in Weston, MA is seeking a part-time Utilization Review Specialist to manage insurance authorizations and maximize reimbursement. The role focuses on precertifications, concurrent certifications, and communicating with insurers to support patient care and billing.

You will gather information, maintain records, and collaborate with clinical and billing teams. The successful candidate has strong Microsoft Office skills, professional communication, and the ability to

Qualifications

• High School diploma or equivalent required; post-high school training preferred.
• At least two years in medicine, chemical dependency/substance abuse/psychiatric or human services.
• Experience in third-party reimbursements.
• Proficiency with verbal and written communication.
• Knowledge of patient confidentiality laws and privacy standards.
• Proficient in Microsoft Office.
• Ability to work in a team and handle multiple tasks under stress.

Responsibilities

• Gather information salient to insurance reimbursement.
• Call insurance companies to obtain precertification or concurrent certification.
• Establish relationships with insurance providers.
• Identify trends in reimbursements and report to supervisor.
• Work closely with all departments.
• Keep accurate records of all transactions and communications with insurances.
• Accurately transfer all information to the Billing Department.
• Maintain a professional workplace and attendance.

Skills

Microsoft Office

Team player

Verbal & written communication

Organizational skills

Interpersonal skills

Education

High school diploma or equivalent

Post high school training in medical/insurance/behavioral health

Nursing license (helpful)

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.

General Office Management Part Time Professional Weston, MA, US

30+ days ago Requisition ID: 1343

Salary Range: $24.00 To $26.00 Hourly

Position Overview:

The primary purpose of the Utilization Review Specialist is to create and manage the flow of revenue for each client through liaison with insurance companies. The Utilization Review Specialist establishes a file on all incoming clients with insurance and maintains authorization for reimbursement from pre-certification through continuing stay reviews through discharge or referral. The Utilization Review Specialist uses communication, reading and writing skills to establish the best, most accurate position of need for each client to ensure maximum reimbursement for care and appropriate reimbursement for the level of care being provided. The Utilization Review Specialist has skills in gathering information from clinicians, navigating EMRs, and creating cases for presentation.

Specific Responsibilities:

• Gather all information salient to insurance reimbursement.
• Call insurance companies to obtain precertification or concurrent certification concurrent with the level of care
• Establish positive relationships with insurance providers.
• Identify trends in reimbursements and report out to supervisor through verbal report and generation of graphics.
• Work closely with all departments
• Keep accurate records of all transaction and communication with insurances.
• Accurately transfer all information to the Billing Department
• Provides corrective criticism and peer review.
• Reported to work as assigned and keep workplace professional.
• Maintain acceptable overall attendance.
• Promote a favorable/positive work atmosphere.
• Maintains safety of the physical environment.
• Communicate effectively both orally and in writing.
• Independently solve problems and follow through.
• Organize and function independently in an office environment.
• Other duties as assigned.

Minimum Qualifications

• High School Graduate or equivalent. Post high school training in the medical field, the insurance field or in the behavioral health field preferred
• A minimum of two years in the field of medicine, chemical dependency/substance abuse/psychiatric setting or human services field. Experience in third party reimbursements.
• Licensure in nursing, social services helpful but not required.
• Ability to work as a team member and have management, communication, organizational and interpersonal skills.
• Ability to work under stressful conditions and be flexible in relation to department needs.
• Understanding of medical and behavioral health terminology
• Demonstrates Proficiency in Verbal and Written Communication Skills.
• Knowledge of State and Federal Statutes Regarding Patient Confidentiality Laws.
• Knowledge of Drug-Free Workplace Policies.
• Knowledge of Corporate Integrity and Compliance Program.
• Knowledge of current utilized technology.
• Understanding of Insurance policy coverage limits.
• Proficient in Microsoft Office
• Satisfactory CORI and background check.