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Utilization Review Representative

2 months ago

Orlando, United States Medusind Full time
Job DescriptionJob DescriptionDescription:

At Medusind we take immense pride in offering superior, cost-effective solutions covering the whole spectrum of tasks and processes to the healthcare industry. A significant factor is that our workforce comes with rich domain expertise and robust compliance norms.

Our four-prong approach of an excellent management team coupled with a detailed eye for processes experienced manpower, and cutting-edge technology helps us deliver superior, cost-effective services to our clients across the globe.

Benefits:

  • Health insurance.
  • Dental insurance.
  • Employer-paid life insurance.
  • Employer-paid short-term & long-term disability.
  • Voluntary additional life insurance.
  • Employee Assistance Program.
  • 48 hours of sick time after three months.
  • 80 hours of vacation time after six months.
  • $400 referral bonus

Position Overview:

  • As a Utilization Review Representative, you will be a key member of the Utilization Review Team as the face to our clients and the client’s liaison to the insurance companies.
  • You must strongly advocate for increasing patient care on behalf of the patients and our clients when working with insurance companies and case managers.
  • This position must demonstrate exceptional customer service skills with the ability to effectively communicate with internal and external customers.

Role & Responsibilities:

  • Successfully conduct pre-authorizations and utilization reviews of behavioral health, substance abuse and mental health cases.
  • Advocate with and for our client’s patients with health insurers to obtain optimal authorization for treatment. Interfaces with clients to obtain necessary clinical documentation for reviews, outcomes and discharge planning.
  • Communicates with insurance and managed care companies to inform them of diagnoses and health status of clients.
  • Represent multiple facilities in utilization reviews, peer-to-peer reviews, etc. in a professional manner.
  • Effectively train and influence facility treatment centers on best practices for recording medical records, increasing authorizations, etc.
  • Demonstrate and value adherence to policies pertaining to patient privacy, following all HIPAA requirements.
  • Other responsibilities as assigned.
Requirements:


  • At least 2-3 years of utilization review and/or clinical experience; emphasis in dual diagnosis with mental health and substance abuse preferred.
  • Must have superior customer service skills.
  • DSM V Experience
  • ASAM criteria comprehension
  • Experience with pre-authorization and utilization reviews.
  • Effective oral and written communication skills with prompt and professional response.
  • Proficiency with Best Notes, Kipu, Availity, and Change Healthcare preferred.
  • Demonstrates understanding of billing revenue codes CPT/HCPCS, diagnosis codes/lCD-10
  • Self-motivated with strong organizational skills and superior attention to detail.
  • Must be able to manage multiple tasks when given.
  • Capable of working within and adapting to new policies, procedures and practices prescribed by the Company.