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Utilization Review Representative

4 months ago

Prescott, United States Medusind Full time
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.

The role of the Utilization Review Specialist is to advocate for patient care at substance abuse treatment facilities by obtaining insurance authorizations for all levels of care. This is a full time, fully remote, fast paced position.

Responsibilities

  • Obtain treatment authorizations from health insurance companies
  • Maintain accurate and timely documentation
  • Function as a member of the Utilization Review Team to ensure that all daily responsibilities are met.
  • Develop collaborative partnership relationships with insurance care managers and health care providers, in order to provide clients with expeditious delivery of service.
  • Ongoing communication with health care providers (our customer's) and support staff through frequent communication and interactions.
  • Respond to insurance denials through the written appeals process when appropriate.
  • File retrospective reviews as needed.
  • Participate in continuing professional education.
  • Perform other duties as assigned or required as part of the UR team.
Competencies

  • Demonstrate ability to independently identify and define potential and/or current issues of concern, collect and analyze data, establish facts, draw valid conclusions, and exercise discretion and sound judgment.
  • Demonstrate written and oral communication skills to formulate business correspondence and convey complex medical and behavioral health information.
Qualifications

  • Knowledge of medical and behavioral health terminology, physiology, concepts of disease and treatment methodologies.
  • Knowledge in reviewing medical and behavioral health records for medical necessity.
  • Skill in operating a personal computer utilizing a variety of software applications a must.
  • Organized and able to meet deadlines consistently.
  • Excellent customer service skills.
  • Strong knowledge base surrounding substance abuse and mental health conditions and Treatment is a must.


About Medusind:

Since 2002, organizations across the entire healthcare spectrum have leveraged our deep expertise and high-quality solutions to maximize revenue, reduce operating costs and navigate the changing healthcare landscape.Medusind’s unique combination of deep industry expertise, robust operational capability, and client-focused service significantly improves the efficiency and profitability of healthcare organizations. Client satisfaction is the primary focus of the Medusind leadership and staff.Our highly experienced personnel, cutting edge technology, and forward thinking approach allows us to deliver effective solutions while staying ahead of healthcare industry changes.