Utilization Review Coordinator | Remote

About the role

Lotus Healthcare Billing is a behavioral health billing operation based in Boca Raton, Florida, supporting treatment programs through insurance authorization, utilization review, and payer communication. The team works closely with clinical staff to ensure patients can access the levels of care they need, from detox through outpatient services.

What You'll Do

• Cultivate daily phone contacts with insurance companies to secure authorizations for behavioral health and substance use disorder treatment.
• Manage a caseload of active authorizations, tracking timelines closely since they directly affect patient care.
• Apply knowledge of SUD and behavioral health levels of care, including detox, residential, PHP, IOP, and outpatient, when communicating with payers.
• Reference ASAM criteria and medical necessity standards to support authorization requests.
• Utilize systems such as KIPU, Availity, or other payer portals to document and track review activity.
• Communicate professionally and consistently with insurance representatives and internal clinical teams.
• Work independently while staying aligned with program and compliance expectations.

Requirements

• A high school diploma or equivalent required; an associate's or bachelor's degree is preferred.
• Less than one year of relevant experience required; training will be provided for the right candidate.
• Experience in utilization review, insurance authorization, or behavioral health billing is preferred.
• Familiarity with SUD/behavioral health levels of care (detox, residential, PHP, IOP, OP) is a strong plus.
• Knowledge of ASAM criteria and medical necessity standards is a plus.
• Experience with KIPU, Availity, or payer portals is preferred.
• Strong organizational skills and attention to detail are essential.
• Clear, professional communication skills are required.
• Comfortable working independently and managing a caseload is important.
• A reliable home internet and a private, HIPAA-compliant workspace for remote work are necessary.

Pay

Salary: $50,000 to $80,000 annually, commensurate with experience.

Schedule

Schedule: Days, full-time, remote (hybrid option available for the right candidate).