Utilization Review Specialist
2 weeks ago
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 SummaryThe 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.
- 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.
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.
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