Utilization Review (UR) Specialist

Spectrum Billing Solutions; Skokie (IL); Hybrid; USD 35,000 - 65,000; Full time

Job summary

Spectrum Billing Solutions, a leader in revenue cycle management for healthcare organizations, seeks a Utilization Review Specialist to join their team. This role involves reviewing clinical information and securing authorizations for behavioral healthcare services. It offers the flexibility of a remote or hybrid work environment and emphasizes detail-oriented individuals who value collaboration. Ideal candidates will have a background in ABA, substance abuse, or mental health and possess strong communication skills. The company provides competitive salaries, healthcare benefits, and opportunities for career growth.

Benefits

Healthcare benefits including 401K

Flexible PTO

Growth opportunities

Competitive salary

Qualifications

• 3-5 years of related ABA, Substance Abuse, and/or Mental Health experience.
• Superior written and oral communication skills.
• Ability to work independently and within a team.

Responsibilities

• Review patient admission to ensure medical necessity for treatment.
• Obtain initial and continuing authorizations for treatment services.
• Advocate for patients to maximize care.

Skills

Attention to detail

Communication skills

Critical decision-making

Advocacy

Education

Bachelor's or Master's degree

Tools

Word

Excel

Billing software

Job description

Spectrum Billing Solutions is an industry-leading revenue cycle management company for healthcare organizations. We are looking to add a Utilization Review (UR) Specialist to our growing team. The UR Specialist will utilize his or her knowledge and skills to review clinical information and obtain initial and continuing authorizations for behavioral healthcare services. The ideal candidate is passionate, motivated, detail-oriented, and interested in working in a cohesive and rewarding environment.

This is a remote or office/home hybrid position.

Responsibilities include:

• Review patient admission and clinical information to ensure medical necessity and compliance of utilization review guidelines
• Obtain initial and continuing authorization for treatment services.
• Manage authorization denials including referral for peer review
• Demonstrate the ability to make critical decisions about medical necessity of treatment by using good judgment
• Advocate on behalf of patients to ensure maximum length of stay at the appropriate level of care.
• Interact with insurance companies in a respectful, professional manner that facilitates the utilization review process and follows policies and procedures
• Document and record all necessary information
• Monitor and track new and ongoing authorization cases
• Collaborate and communicate with clinical staff to ensure necessary information is obtained and timely reviews are performed
• Assist the treatment team in understanding payer requirements for admission, continued stay and discharge planning
• Participate in team meetings and case conference reviews
• Perform other duties as assigned
• Maintain confidentiality of patient information and adhere to HIPAA regulations
  
  

Minimum requirements:

• 3-5 years of related ABA, Substance Abuse, and/or Mental Healthexperience
• Bachelor’s or master’s degree preferred
• Superior written and oral communication skills
• Attention to detail to ensure necessary information is captured and properly documented
• Ability to work independently and within a team
• Ability to multi-task, prioritize and meet expected deadlines
• Solid understanding of insurance benefits and coverages.
• Strong computer skills (Word, Excel, billing software)
• Understanding of mental and behavioral health treatment services.
  
  

At Spectrum, you receive:

• A close-knit team of talented and skilled individuals
• Growth opportunities within the organization
• Competitive salary
• Healthcare benefits including 401K, medical, dental &vision
• Flexible PTO
  
  

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Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Other

• Industries

  Internet Publishing

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