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

Wyndy

Before & After School Nanny Job at Wyndy

 ...both aged 9. The role involves providing care before school three mornings a week and after school five days a week. The family values...  ...Thursday, days may vary) and after-school care from 1:45 PM to early evening, Monday through Friday. This includes driving the girls... 

BMO US

Bank Manager Job at BMO US

 ...activities to meet strategic customer experience and profitability goals in compliance with legal and regulatory requirements and the Bank's policies and processes.U.S. Only: This position will act as an originator of consumer loans as defined by Regulation Z,... 

Amazon.com Services LLC

Sr. Front End Engineer, Amazon Shopping Videos (Ads) Job at Amazon.com Services LLC

 ...engineer on the Amazon Live Core Services team, you will develop a best in class video processing and content viewing...  ...customers regularly. BASIC QUALIFICATIONS - 4+ years of non-internship professional front end, web or mobile software development using JavaScript, HTML... 

Sevita

Community Outreach Worker Job at Sevita

 ...family** **,** provides Residential and Treatment Foster Care services to youth who may be facing out-of-home placements, transitioning...  ...our mission-driven team and experience a career well lived.**Community Outreach Worker****Part-time/ up to 20 hrs a week-- $20/hr**... 

Daiichi Sankyo, Inc.

Senior Director, Global Clinical Operations - Early Phase Job at Daiichi Sankyo, Inc.

 ...of care and address diversified, unmet medical needs of people globally by leveraging our world-class science and technology. With more...  ...around rare diseases and immune disorders. Summary The Senior Director of Clinical Operations will manage clinical operations staff to...