Lead Utilization Revenue Rep

3 weeks ago

Bakersfield, United States Embark Behavioral Health Full time

Overview:
**Lead Utilization Review Representative**

**Pay**: $22.00 - 24.00 per hour

The primary responsibility for the Lead Utilization Review Rep is to oversee the basic daily functions of the Utilization Review Team. The Lead Utilization Review Rep is responsible to ensure all SLAs are met, KPIs are maintained, and to be a liaison between the UR Team and the stakeholders of Embark Behavioral Health. The Lead UR Rep will ensure authorizations are completed timely and will also ensure all UR Reps complete regular training. They will be responsible for assisting with new program stand up, and training of new UR Reps. The UR Lead will be responsible for completing all necessary appeals and engaging in denial trend reviews and root cause analysis of such with the Utilization Review Director.

The Lead Utilization Review Rep must be professional, a self-starter who is able to work in a fast-pace and high-stress environment, and an individual who is self-motivate with the ability to multitask well. This individual must be a team player and work well in a close environment with others. The purpose of the position is to ensure the success of the UR Reps, which will also ensure longevity of treatment for clients and families.

Embark Behavioral Health is a unique organization comprised of extraordinary programs dedicated to bringing the current all-time high rates of adolescent anxiety, depression, and suicide to all-time lows within the decade while becoming the most recognizable, respected, and valuable behavioral health organization in the world. Embark is a leading network of clinical and therapeutic programs (residential treatment centers, young adult transition programs, outpatient centers, addiction treatment facilities, wilderness therapy programs, support services, and more) that offer a comprehensive set of services that run the span of acuities, ages, and services. All programs offer state-of-the-art therapeutic interventions, lead the way in quality standards, deliver measurable outcomes and are all tied together via a shared set of core values (empathy, service, trust, growth, and results).

**Responsibilities**:

- Work with the Director of Utilization Review to ensure the Utilization Review Team achieves objectives and KPIs.
- Ensure all UR Reps receive regular and mandatory training both upon hire, and throughout employment.
- Assist with the standup of new programs
- Training clinicians and program staff at regular intervals
- Engaging in necessary appeals and retro-reviews
- Ensure timely SCA negotiations and executions
- Ensure all potential clients receive appropriate certifications for services “to be” rendered by working closely with insurance companies, therapists, and billing department.
- Execute effective communication with clients/families and billing department.
- Communicate regularly with the various treatment team providers.
- Monitor the fulfillment of all documentation requirements.
- Make recommendations to define and improve quality of processes.
- Monitor assigned facility data reports.
- Research all “denials” with a forensic record review in a timely manner with a follow-up plan of correction. Then implement the plan of correction with the corresponding facility heads, providers and payors for an expedient resolution.
- Assist with on-going education for treatment team providers regarding their role in maintaining documentation standards for all clients.
- Interface with managed care organizations, external reviews and other payors.
- Other duties as assigned and appropriate.

Qualifications:

- High School/GED required; Associate degree preferred
- 2-3 years of Utilization Review experience required
- Customer Service experience required
- Team player required, must be able to work in a team environment
- HIPAA Certification required upon employment
- Ability to maintain confidentiality in compliance with HIPPA Guidelines
- Understanding of medical terminology, diagnostic terms, and treatment modalities.
- Strong and professional communication skills
- Skilled in negotiation and problem-solving aptitude
- Patience and ability to manage stress and maintain confidentiality
- Strong written and verbal communication skills
- Exceptional organizational skills and attention to detail
- Self-starter, self-sufficient, self-confident leading to an ability to create a system for medical records and communication with Embark families in multiple programs

**Benefits**:

- Enjoy a comprehensive Benefits Program, encompassing medical insurance with a generous company contribution towards a high deductible plan, dental insurance, vision insurance, voluntary life and AD&D insurance, long-term disability, 401K with company matching, and paid maternal leave.
- Revel in the balance of Company Paid Holidays and a PTO accrual schedule.
- At Embark, we and our team members embody core values of empathy, trusting relationships, service, growth, and results. Join us in making a meaningfu

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