Utilization Review Specialist - Payer & Compliance

Rimrock; Billings (MT); Hybrid; USD 52,000 - 68,000; Full time

Job summary

Rimrock seeks a Utilization Review (UR) Coordinator to manage the administrative components of utilization review for all levels of care and payers. You will track authorizations from admission through discharge, request clinical documentation, and submit timely submissions while coordinating with billing and clinical leadership to ensure compliance with HIPAA and state/federal requirements.

The role emphasizes non-clinical management, data accuracy, and process improvement within a

Qualifications

• High school diploma or equivalent; associate degree preferred.
• Two years of healthcare billing, prior authorizations, insurance verification, medical records, or a medical office setting.
• Experience with Montana Medicaid, ASAM levels of care, and BHDD Medicaid Provider Manual preferred; professional certifications (CPB/CRCS/RHIT) preferred.

Responsibilities

• Maintain the UR tracker as the single record of every authorization across Medicaid and commercial payers.
• Verify payer eligibility and authorization requirements at admission with admissions and billing.
• Submit authorization requests through payer portals, fax, and telephone within required timeframes.
• Request clinical documentation with clear due dates and track each request.
• Log determinations, requests for information, and denials with timely responses.
• Prepare and file requests for reconsideration and track to resolution.

Skills

Organization

Deadline management

Written communication

Verbal communication

Attention to detail

Records management

Problem solving

Education

High school diploma or equivalent

Associate degree (health information management / medical billing / business) preferred

Tools

Electronic health record systems

Payer portals

Microsoft Word

Microsoft Excel

Microsoft Outlook

Job description

Rimrock seeks a Utilization Review (UR) Coordinator to manage the administrative components of utilization review for all levels of care and payers. You will track authorizations from admission through discharge, request clinical documentation, and submit timely submissions while coordinating with billing and clinical leadership to ensure compliance with HIPAA and state/federal requirements.

The role emphasizes non-clinical management, data accuracy, and process improvement within a