Utilization Review Specialist: Payer Communications

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

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.