Utilization Review (UR) Specialist Job at Spectrum Billing Solutions, Skokie, IL

SUs0dlhkY1ZJWHlyRVFDRHRTcXF5c2NhN1E9PQ==
  • Spectrum Billing Solutions
  • Skokie, IL

Job Description

Spectrum Billing Solutions is an industry-leading revenue cycle management company for healthcare organizations. We are looking to add a Utilization Review (UR) Specialist to our growing team. The UR Specialist will utilize his or her knowledge and skills to review clinical information and obtain initial and continuing authorizations for behavioral healthcare services.  The ideal candidate is passionate, motivated, detail-oriented, and interested in working in a cohesive and rewarding environment.

This is a remote or office/home hybrid position.

Responsibilities include:

  • Review patient admission and clinical information to ensure medical necessity and compliance of utilization review guidelines.
  • Obtain initial and continuing authorization for treatment services.
  • Manage authorization denials including referral for peer review.
  • Demonstrate the ability to make critical decisions about medical necessity of treatment by using good judgment.
  • Advocate on behalf of patients to ensure maximum length of stay at the appropriate level of care.
  • Interact with insurance companies in a respectful, professional manner that facilitates the utilization review process and follows policies and procedures.
  • Document and record all necessary information.
  • Monitor and track new and ongoing authorization cases.
  • Collaborate and communicate with clinical staff to ensure necessary information is obtained and timely reviews are performed.
  • Assist the treatment team in understanding payer requirements for admission, continued stay and discharge planning.
  • Participate in team meetings and case conference reviews.
  • Perform other duties as assigned.
  • Maintain confidentiality of patient information and adhere to HIPAA regulations

Minimum requirements:

  • 3-5 years of related ABA, Substance Abuse, and/or Mental Health experience.
  • Bachelor’s or master’s degree preferred.
  • Superior written and oral communication skills
  • Attention to detail to ensure necessary information is captured and properly documented.
  • Ability to work independently and within a team.
  • Ability to multi-task, prioritize and meet expected deadlines.
  • Solid understanding of insurance benefits and coverages.
  • Strong computer skills (Word, Excel, billing software).
  • Understanding of mental and behavioral health treatment services. 

At Spectrum, you receive:

  • A close-knit team of talented and skilled individuals.
  • Growth opportunities within the organization.
  • Competitive salary.
  • Healthcare benefits including 401K, medical, dental & vision.
  • Flexible PTO.

Job Tags

Full time, Remote job, Flexible hours,

Similar Jobs

New Horizon Academy

HR Specialist - Benefits & Compliance Job at New Horizon Academy

 ...The HR Specialist Benefits and Compliance supports a variety of human resource processes throughout the multi-state operations of New Horizon Enterprises, which includes assisting with the administering of benefit plans, communicating with employees, and supporting... 

Surgical Medical Device Sales- $175k Plus

Medical Sales Representative Job at Surgical Medical Device Sales- $175k Plus

 ...Medical Device Company specializing in operating room surgical products. Company is publicly traded, 45 years in the market and global...  ...neurosurgery Great company culture, small company atmosphere, 60 sales rep in US $80k base salary $175k 1st year comp Full... 

Sci-Rec

Histology Technician Job at Sci-Rec

 ...coordination, regulatory compliance, and interdepartmental collaboration. Key Responsibilities: Perform routine and specialized histology procedures under general direction with high precision and accuracy Troubleshoot and resolve histology-related issues... 

Ski Town Media Inc.

Office Manager Job at Ski Town Media Inc.

 ...Company Description Ski Town Media Inc. is the publisher of Steamboat Magazine, Steamboat Springs Visitors' Guide, Yampa Valley Arts and Culture Guide and Swillin' & Chillin', along with managing 5 websites and 10 social media channels. Role Description... 

Brooksource

Application Tester Job at Brooksource

 ...Role Overview: We are looking for an experienced QA Tester to support a website expansion project. You will manually test new features like sign-in/sign-up, guest check-out, and multi-language checkout, ensuring a seamless user experience and bug-free functionality...