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Utilization Review Specialist

2 months ago

Delray Beach, Florida, United States Staffosaurus Full time
About the Job

Staffosaurus is a leading Billing Management Company that prioritizes the best interests of its clients. Our mission is to provide a low-cost RCM solution that maximizes insurance reimbursements in the quickest possible time, while maintaining the highest level of professionalism, ethics, and transparency.

Job Summary

The Utilization Review Specialist is responsible for performing utilization review to ensure appropriate reimbursement by third-party payers. This includes managing concurrent reviews for multiple locations and levels of care, the denial/appeals process, as well as the flow, organization, and reporting of information.

Key Responsibilities
  • Obtaining Preauthorization: Obtain preauthorization for admissions and continued stays according to third-party guidelines within one business day of admission, including researching and obtaining necessary insurance contact information and coordinating scheduled meetings between hospital and insurance doctors.
  • Managing Denials/Appeals: Manage and perform the processes for retrospective authorizations and denials/appeals.
  • Communication: Timely communicate preauthorization outcomes, follow-up instructions, options, and related information to relevant administrative and clinical staff, including responding to all calls and emails within one business day unless otherwise required.
  • Documentation: Document activity in Billing and UR software and prepare reports for meetings and management review.
  • Organization: Organize and file documents for ease of access in approved locations.
  • Data Analysis: Assist in compiling information for data analysis relating to preauthorization and reimbursement.
  • Confidentiality: Maintain patient confidentiality in accordance with state and federal law.
  • Team Collaboration: Participate in internal information meetings, required in-service education and training, and company-wide performance improvement and compliance activities.
Requirements
  • Education: Master's degree from an accredited college or university in social work, mental health, nursing, or related degree.
  • Experience: Two years of UR experience in a hospital or healthcare insurance setting.
  • Licensure: LMSW, LMHC, LPC, or other healthcare-related licensure preferred.
Benefits

Staffosaurus offers competitive pay and benefits, including medical, vision, dental, life insurance, retirement plans, and PTO. We believe in training and support to foster the growth of our team and provide a positive and fulfilling work environment.