Utilization Review Specialist

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🔥 11 minutes ago

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Remote Raven

WebsiteLinkedInAll Job Openings

11 - 50 employees

👥 HR Tech

🎯 Recruiter

🤝 B2B

HR Tech • Recruitment • B2B

Remote Raven is a company that connects businesses with highly qualified virtual assistants to fill various roles across multiple industries. They focus on providing professional, college-educated, and well-trained remote workers from the Philippines who can handle diverse tasks, including customer service, bookkeeping, digital marketing, HR, healthcare, and web development among others. Remote Raven ensures that these remote workers are fluent in English and hold relevant degrees or certifications. They offer a simple and affordable recruiting process without start-up fees, aiming to help companies streamline their staffing needs with reliable remote personnel.

📋 Description

• Manage and submit preauthorization requests to insurance providers for clients entering treatment at Residential, Partial Hospitalization Program (PHP), Intensive Outpatient Program (IOP), and Standard Outpatient (OP) levels of care. • Ensure all required documentation is complete and accurately reflects the clinical needs of the client. • Communicate with insurance companies to secure timely approvals for necessary services. • Negotiate and manage Single Case Agreements with insurance providers for clients needing services outside of network coverage. • Monitor ongoing treatment needs and submit continued authorization requests for Residential, PHP, IOP, and OP levels of care to ensure uninterrupted client care. • Collaborate with the clinical team to ensure a comprehensive understanding of each client when asking for continued authorization. • Attend regular meetings with clinical staff to discuss client progress, treatment plans, and authorization needs. • Act as a liaison between clients, clinical teams, and insurance providers to advocate for the necessary care. • Ensure all utilization review activities comply with relevant regulations, insurance policies, and organizational standards.

🎯 Requirements

• Education: Bachelor's degree in healthcare administration, social work, or a related field is preferred. • Experience: At least 3-5 years of experience in utilization review, medical billing, or a related field, preferably in a behavioral health setting. • Skills: • - Strong understanding of insurance authorization processes, including preauthorization, continued authorization, SCAs, and multiple levels of care. • - Excellent communication and negotiation skills with the ability to advocate effectively for client needs. • - Proficiency in electronic medical records (EMR) systems and documentation standards. • - Ability to collaborate with clinical staff and provide training on complex topics in a clear and supportive manner. • - Detail-oriented with strong organizational and time-management skills.