Utilization Review Coordinator (UR Coordinator)

About the Role

The Utilization Review Coordinator (UR Coordinator) performs 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

• Clinical Data Review – Review clinical data, including medical records, patient charts, and provider notes to understand patient history and gain a solid understanding of individual patient circumstances, needs, and medical necessity for purposes of admission and/or continued stay advocacy.
• Insurance Review Calls – Communicate clinical information to insurance companies to obtain authorization to treat and/or facilitate continued stay. Utilize knowledge of the billing process and clinical data to present viable arguments for insurance coverage.
• Appeals Advocacy – Speak with clinicians at insurance companies upon denial of coverage to communicate relevant clinical information and highlight individualized patient issues that necessitate coverage for prior treatment. Utilize facts to communicate in a knowledgeable, persistent, passionate, and/or creative manner to achieve desired results for the client base.

Qualifications

• 4+ years of prior experience in a utilization review capacity or equivalent experience.
• Must demonstrate prior experience, knowledge of the insurance industry, and/or aptitude for effective claim advocacy.
• Understanding of the utilization review process; prior patient care or related work experience in the substance abuse, behavioral, and/or mental health treatment field required.
• Prior experience as a behavioral health technician, verification specialist, appeals specialist, and/or other support staff in treatment facilities is highly desirable.
• Strong computer skills and knowledge of MS Office products, including MS Excel; ability to quickly navigate between platforms necessary.
• Strong written and verbal communication skills are a must.
• College degree preferred but not required.
• Medical and/or clinical background/education is preferred but not required.

Schedule

Monday through Friday from 9:00 AM to 5:00 PM. This is not a remote position.