Aba Utilization Review Specialist

Summary

Join Spectrum Billing Solutions as an ABA Utilization Review (UR) Specialist! We offer industry-leading revenue cycle management services and are seeking a passionate, detail-oriented individual to review clinical information, obtain authorizations for ABA services, manage denials, and collaborate with clinical staff. This role requires strong communication and computer skills, along with experience in ABA and behavioral health. We provide a flexible work environment, competitive salary, growth opportunities, and comprehensive benefits including medical, dental, vision, PTO, 401k, and supplemental benefits. The ideal candidate will possess a Bachelor's or Master's degree and a solid understanding of insurance benefits and coverages.

Requirements

• 3-5 years of related ABA and/or Behavioral Health experience
• 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

Responsibilities

• 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
• 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 external clients in understanding payer requirements for authorizations
• Participate in team meetings
• Maintain confidentiality of patient information and adhere to HIPAA regulations

Preferred Qualifications

Bachelor’s or master’s degree

Benefits

• Flexible work environment – You can work from home, hybrid or fully in office
• Competitive Salary – based on years of experience
• A close-knit team of talented and skilled individuals
• Growth opportunities – We are a growing company and want to promote within our team
• Benefits – Medical, Dental, Vision
• Flexible Paid Time Off – 2 weeks PTO time, which increases with your tenure
• 401K – with Company match
• Supplemental Benefits