Utilization Review (UR) Specialist Job at Spectrum Billing Solutions, Skokie, IL

ay8ycDMxNXlDK0hwTWJkTWpDeUV3ZGVuMmc9PQ==
  • Spectrum Billing Solutions
  • Skokie, IL

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 Health experience.
  • 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.

Job Tags

Full time, Remote job, Flexible hours,

Similar Jobs

The Permanente Medical Group, Inc.

Hematology/Oncology Job at The Permanente Medical Group, Inc.

The Permanente Medical Group, Inc. is seeking physicians who are board certified or board eligible by an American Medical Specialty Board. BENEFITS PACKAGE (*approval required): Comprehensive vision, medical, and dental Interest Free Home Loan Program up to $25...

University of Miami

Pharmacy Technician 1, Part Time Job at University of Miami

 ...University of Miami has an exciting opportunity for a Part Time Pharmacy Technician 1. The Pharmacy Technician 1 prepares medications for...  ...school diploma or equivalent State of FL registration No experience required. {New Grad/Entry} The University of Miami... 

H2 Performance Consulting Corporation

Medical Office Manager Job at H2 Performance Consulting Corporation

 ...testing company in the Florida Panhandle. H2's sister company is looking for an energetic and organized individual to fill our Medical Office Manager job in our Fort Walton Beach, FL location. This job is perfect for a qualified CMA that is wanting to take the next step... 

Milwaukee Habitat for Humanity

Construction Assistant Job at Milwaukee Habitat for Humanity

 ...Construction Assistant Full-Time, FT - Hourly / Non-Exempt Tuesday Saturday schedule 7:30 am-3:30 pm Job Summary The Construction Assistant plays an integral part in helping us build new single-family homes. The Construction Assistant works with our Construction... 

DSV - Global Transport and Logistics

Yard Driver - 2nd shift Job at DSV - Global Transport and Logistics

 ...customers. Read more at Location: USA - Wichita, 3298 S. Turnpike Drive, Bldg 1-338G Division:SolutionsJob Posting Title: Yard Driver - 2nd shiftTime Type: Full Time Role Summary: The Driver role staff will play a crucial role in delivering and picking up...