Utilization Review Specialist

2 weeks ago


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

Congress Billing 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 shortest time possible, 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, and the flow, organization, and reporting of information.

Responsibilities
  • Obtain preauthorization for admissions and continued stays according to third-party guidelines within one business day of admission.
  • Manage and perform the processes for retrospective authorizations and denials/appeals.
  • Timely communicate preauthorization outcomes, follow-up instructions, options, and related information to relevant administrative and clinical staff.
  • Document activity in Billing and UR software and prepare reports for meetings and management review.
  • Organize and file documents for ease of access in approved locations.
  • Assist in compiling information for data analysis relating to preauthorization and reimbursement.
  • Maintain patient confidentiality in accordance with state and federal law.
  • Participate in internal information meetings, required in-service education and training, and company-wide performance improvement and compliance activities.
Requirements
  • Master's degree from an accredited college or university in social work, mental health, nursing, or a related field.
  • Knowledge of behavioral health systems and utilization management.
  • Two years of UR experience in a hospital or healthcare insurance setting.
  • LMSW, LMHC, LPC, or other healthcare-related licensure preferred.
Benefits

Congress Billing 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.

Pay and Schedule

$60,000-$70,000 per year. Full-time, remote position.



  • Delray Beach, Florida, United States Staffosaurus Full time

    About the JobUtilization Review SpecialistAt Staffosaurus, we are seeking a highly skilled Utilization Review Specialist to join our team. As a Utilization Review Specialist, you will play a critical role in ensuring that our clients receive the best possible care while minimizing costs.ResponsibilitiesObtain preauthorization for admissions and continued...


  • Delray Beach, Florida, United States Staffosaurus Full time

    About the JobCongress Billing 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 time possible, while maintaining the highest level of professionalism, ethics, and transparency.Job SummaryThe Utilization Review...


  • Delray Beach, Florida, United States Delray Medical Center Full time

    Diagnostic Imaging SpecialistDelray Medical Center is seeking a skilled Diagnostic Imaging Specialist to join our team. As a Diagnostic Imaging Specialist, you will be responsible for performing diagnostic procedures utilizing radiation detection and imaging equipment.Key Responsibilities:Produce high-quality images in a safe and efficient manner.Complete...


  • Delray Beach, Florida, United States Delray Medical Center Full time

    Diagnostic Imaging SpecialistDelray Medical Center is seeking a skilled Diagnostic Imaging Specialist to join our team. As a Diagnostic Imaging Specialist, you will be responsible for performing diagnostic procedures utilizing radiation detection and imaging equipment.Key Responsibilities:Produce high-quality images in a safe and efficient manner.Complete...


  • Delray Beach, Florida, United States Delray Medical Center Full time

    Diagnostic Imaging SpecialistDelray Medical Center is seeking a skilled Diagnostic Imaging Specialist to join our team. As a Diagnostic Imaging Specialist, you will be responsible for performing diagnostic procedures utilizing radiation detection and imaging equipment.Key Responsibilities:Produce high-quality images in a safe and efficient manner.Complete...


  • West Palm Beach, Florida, United States Dane Street, LLC Full time

    {"h1": "Physician Reviewer: Physical Medicine and Rehabilitation Specialist", "p": "At Dane Street, LLC, we offer a unique opportunity for a Physician Reviewer to join our team in a Physical Medicine and Rehabilitation specialist role. As a telework opportunity, you will have the flexibility to customize your schedule and caseload within the week while...


  • West Palm Beach, Florida, United States St. Mary's Medical Center Full time

    Job SummaryWe are seeking a skilled Registered Nurse to join our team as a Clinical Utilization Specialist. In this role, you will be responsible for utilization review and discharge planning of all acute clinical areas.Key ResponsibilitiesConduct thorough utilization reviews to ensure accurate and efficient careDevelop and implement effective discharge...

  • Billing Specialist

    2 weeks ago


    Delray Beach, Florida, United States Children of America Full time

    {"title": "Billing Specialist", "description": "About Children of AmericaWe are a special blend of people, principles, and pride that creates a diverse and strong community.Our diverse and dedicated team is the backbone of COA's strength.We are seeking a motivated and experienced Billing Specialist to contribute to our team's success.Key...


  • West Palm Beach, Florida, United States St. Mary's Medical Center Full time

    Job SummaryWe are seeking a skilled Registered Nurse to join our team as a Clinical Utilization Specialist. In this role, you will be responsible for reviewing patient cases and developing effective discharge plans to ensure seamless transitions of care.Key ResponsibilitiesConduct thorough reviews of patient cases to identify opportunities for improved care...


  • Saint Augustine Beach, Florida, United States University of Florida Health Full time

    Job SummaryWe are seeking a skilled RN Utilization Management Specialist to join our team at the University of Florida Health. As a key member of our healthcare team, you will play a critical role in ensuring that patients receive the most appropriate level of care, while also promoting efficient use of hospital resources.Key ResponsibilitiesConduct thorough...


  • Delray Beach, Florida, United States Soliant Full time

    Electrophysiology (EP) Lab Technician Job OpportunityWe are seeking a skilled Electrophysiology (EP) Lab Technician to join our team on a travel contract basis. The ideal candidate will have a minimum of 1+ years of experience in an EP lab setting and be certified as a Registered Cardiovascular Invasive Specialist (RCIS) or Registered Electrophysiology...

  • Accounting Specialist

    2 weeks ago


    Delray Beach, Florida, United States Delray Beach, Florida Full time

    Job Title: Accounting SpecialistDelray Beach, Florida is seeking a highly skilled Accounting Specialist to join our team.Job Summary:The Accounting Specialist will be responsible for performing advanced bookkeeping, accounting, and clerical work under general supervision. The ideal candidate will have a strong background in accounting principles, collection...


  • Delray Beach, Florida, United States Plastimold Products Inc Full time

    Job Title: Quality Assurance SpecialistWe are seeking a detail-oriented Quality Assurance Specialist to ensure our products meet quality standards and regulatory requirements. The successful candidate will be responsible for carrying out inspections, reading 2D drawings, and utilizing measurement equipment such as calipers and micrometers.Key...

  • QNXT Specialist

    1 week ago


    Delray Beach, Florida, United States ClinDCast LLC Full time

    Job Title: QNXT SpecialistWe are seeking a highly skilled QNXT Specialist to join our team at ClinDCast LLC. As a key member of our healthcare payer operations team, you will be responsible for leveraging your expertise in the QNXT data model to design and implement innovative solutions that drive business growth and efficiency.Key Responsibilities:Utilize...

  • Paralegal Specialist

    2 weeks ago


    Pompano Beach, Florida, United States Denovo Review Full time

    Job OpportunityDenovo Review, a rapidly growing Florida-based law firm, is seeking a highly skilled and motivated Paralegal to join our team. As a Paralegal, you will play a crucial role in supporting our Workers Compensation and Personal Injury practice.Key Responsibilities:Assist in drafting and managing discovery requests and responses.Prepare medical...


  • Delray Beach, Florida, United States ClinDCast LLC Full time

    Job Title: Adobe CJA Data Integration SpecialistClinDCast LLC is seeking a highly skilled Adobe CJA Data Integration Specialist to join our team.Key Responsibilities:Data Integration Management: Oversee the integration of data from Adobe Experience Platform (AEP) to Adobe Customer Journey Analytics (CJA).Data Analysis: Analyze large datasets within CJA to...

  • Accounting Specialist

    4 weeks ago


    Delray Beach, Florida, United States Sage Dental Full time

    Financial Expertise Wanted **Job Summary** We are seeking a highly skilled accounting professional to join our team at Sage Dental. As an Accounting Specialist, you will play a critical role in ensuring the accuracy and timeliness of our financial records. **Key Responsibilities** * Perform bank reconciliations and support month-end closing activities...


  • Delray Beach, Florida, United States HeliosX Full time

    About the RoleWe are seeking a skilled physician to join our team at HeliosX, a leading healthcare company that is revolutionizing the way healthcare is delivered. As a telemedicine specialist, you will play a critical role in providing high-quality patient care and treatment through our innovative telemedicine platform.Key Responsibilities:Review and...


  • Delray Beach, Florida, United States Florida Cancer Specialists Full time

    About the RoleWe are seeking a skilled Radiation Oncology Coder to join our team at Florida Cancer Specialists & Research Institute. As a Radiation Oncology Coder, you will play a critical role in ensuring that all services rendered are captured timely, coded accurately, and meet documentation requirements when processed through the EMR and Billing...


  • West Palm Beach, Florida, United States Denovo Review Full time

    Job OpportunityDenovo Review, a highly regarded full-service insurance defense firm, is seeking an experienced Litigation Paralegal to join their team in West Palm Beach, Florida. This position offers a flexible and enjoyable work environment, including hybrid and remote options, prioritizing work-life balance.About the Role:Minimum 3-5 years of Litigation...