Utilization Review Specialist

Summary

Join Spectrum Billing Solutions, a leading revenue cycle management company, as a Utilization Review (UR) Specialist! This remote or hybrid position requires reviewing clinical information, obtaining authorizations for behavioral healthcare services, and managing denials. You will advocate for patients, interact with insurance companies, and collaborate with clinical staff. The ideal candidate possesses strong communication, detail-oriented skills, and experience in ABA, substance abuse, or mental health. Spectrum offers a supportive team environment, growth opportunities, competitive salary, and comprehensive healthcare benefits.

Requirements

• 3-5 years of related ABA, Substance Abuse, and/or Mental 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
• 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

Preferred Qualifications

Bachelor’s or master’s degree

Benefits

• 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