Healthcare Solutions Specialist

6 days ago


Tustin, California, United States Medusind Full time

At Medusind, we pride ourselves on delivering superior, cost-effective solutions to the healthcare industry. Our workforce boasts rich domain expertise and robust compliance norms.

We employ a four-pronged approach that combines an excellent management team with detailed process expertise, experienced personnel, and cutting-edge technology to deliver exceptional services globally.

Benefits include:

  • Comprehensive health insurance
  • Dental insurance
  • Employer-paid life insurance
  • Short-term and long-term disability coverage
  • Voluntary additional life insurance
  • An Employee Assistance Program (EAP)
  • Sick time: 48 hours after three months
  • Vacation time: 80 hours after six months
  • A $400 referral bonus

This role has an expected start date of November 15, 2024.

Position Overview:

  • As a Healthcare Solutions Specialist, you will be a key member of the Utilization Review Team, serving as the primary point of contact for clients and liaison between clients and insurance companies.
  • You will advocate strongly for increased patient care when working with insurance companies and case managers.
  • This position requires exceptional customer service skills, with the ability to effectively communicate with internal and external customers.

Key Responsibilities:

  • Conduct pre-authorizations and utilization reviews of behavioral health, substance abuse, and mental health cases
  • Advocate with and for client patients to obtain optimal treatment authorization from insurers
  • Interface with clients to obtain necessary clinical documentation for reviews, outcomes, and discharge planning
  • Communicate with insurance and managed care companies regarding diagnoses and health status of clients
  • Represent multiple facilities in utilization reviews, peer-to-peer reviews, etc., in a professional manner
  • Train facility treatment centers on best practices for recording medical records, increasing authorizations, etc.
  • Maintain adherence to policies related to patient privacy, following HIPAA requirements
  • Other responsibilities as assigned

Requirements:

  • 2-3 years of experience in utilization review and/or clinical settings, with a focus on dual diagnosis and mental health/substance abuse preferred
  • Superior customer service skills
  • DSM V Experience
  • Understanding of ASAM criteria
  • 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
  • Understanding of billing revenue codes CPT/HCPCS, diagnosis codes ICD-10
  • Self-motivated with strong organizational skills and attention to detail
  • Ability to manage multiple tasks efficiently
  • Capacity to adapt to new policies, procedures, and practices prescribed by the Company

About Medusind:

We have been helping organizations across the entire healthcare spectrum since 2002, leveraging 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, operational capability, and client-focused service significantly improves efficiency and profitability for healthcare organizations.

Our highly experienced personnel, cutting-edge technology, and forward-thinking approach enable us to deliver effective solutions while staying ahead of healthcare industry changes.



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