Utilization Review Specialist - Insurance Auths & Access

Abhs; Donlontown (NJ); On-site; USD 55,000 - 65,000; Full time

Job summary

Abhs in Marlton, NJ is seeking an Utilization Review Specialist who will process insurance authorizations for partial hospitalization, intensive outpatient, and outpatient programs, ensuring timely and appropriate services for clients.

The role requires strong communication, attention to detail, and the ability to work with multiple departments; experience with EMR systems and Microsoft Office is preferred, with flexibility for varied schedules.

Qualifications

• At least 1 year of Utilization Review experience.
• Experience with electronic medical records (EMR).
• Proficiency in Microsoft Office applications.

Responsibilities

• Handle the continuum of the utilization process for all ABHS entities.
• Outreach to insurance companies to gain authorizations for services such as TMS, partial hospitalization, intensive outpatient and outpatient programming.
• Maintain ongoing communication with the Patient Access Center, Billing Department, Clinical Department and Medical Department.
• Evaluate and assure adequacy of clinical information to screen for medical necessity
• Consultation with internal Clinical and Medical staff regarding alternate services and clinical criteria

Skills

Interpersonal communication

Customer service

Team collaboration

Attention to detail

Education

High School Diploma or equivalent

Tools

Electronic Health Records (EMR) systems

Microsoft Office (Excel, Word, PowerPoint)

Job description

Abhs in Marlton, NJ is seeking an Utilization Review Specialist who will process insurance authorizations for partial hospitalization, intensive outpatient, and outpatient programs, ensuring timely and appropriate services for clients.

The role requires strong communication, attention to detail, and the ability to work with multiple departments; experience with EMR systems and Microsoft Office is preferred, with flexibility for varied schedules.