[Remote] Utilization Review Specialist
Note: The job is a remote job and is open to candidates in USA. Compass Health Center is a recognized leader in crisis-level mental health, providing patient-centered care in the Behavioral Health space. The Utilization Review Specialist will obtain insurance authorization for patients, act as a liaison between the clinical team and insurance companies, and advocate for patients to overcome financial barriers to treatment.
Responsibilities
- Contacting Insurance companies to verify insurance coverage and obtaining approval of treatment as recommended by the clinical team
- Collaborating with the clinical team to compile treatment plans and supporting clinical documentation
- Working with all internal departments as necessary, such as Revenue Cycle and Patient Advocates
- Accurately documenting Electronic Medical Records to reflect approval or denial of treatment authorization
- Communicating insurance authorizations/denials and insurance needs to appropriate internal staff
- Scheduling and delivering concurrent authorization reviews as required by individual insurance companies
- Coordinating physicians’ reviews and appeals
Skills
- Previous healthcare or insurance experience
- Knowledge of medical terminology and psychiatric criteria
- Have the ability to analyze and communicate clinical information from progress, group and psychiatric chart notes
- Have the ability to work autonomously and independently while working collaboratively as part of a team
- Have the ability to think critically and make decisions within individual role and responsibility
- Possess strong written and verbal skills
- Have strong organizational and time management skills with ability to manage workload independently
- Have the ability to foster and maintain positive relationships externally and internally
- Bachelor's Degree (preferred) or relevant experience
- Familiarity with Microsoft Office, Outlook, and EMR
Benefits
- Comprehensive medical/dental/vision plans
- 401k program with company matching
- Generous PTO (including competitive parental leave after 1 year of employment)
- Continuous training through CEU seminars and volunteering opportunities
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