Utilization Review Specialist
About This Role
We are seeking a REMOTE Utilization Review Specialist to obtain appropriate insurance authorization for our patients to receive Behavioral Health treatment at high levels of care. The UR Specialist will act as the liaison between the clinical team and the insurance company, facilitating and maintaining insurance approval through a patient's treatment at Compass Health Center. This person will advocate on behalf of the patient to overcome financial barriers to treatment.
Our dedicated operations teams work behind the scenes to bring our shared mission to life. Each department delivers their own set of strengths which empower our clinicians to focus on their expertise, and ultimately perform the meaningful work that we do.
Responsibilities
- Contacting insurance companies to verify insurance coverage and obtaining approval of treatment as recommended by the clinical team.
- Collaborating with the clinical team to compile treatment plans and supporting clinical documentation.
- Working with all internal departments as necessary, such as Revenue Cycle and Patient Advocates.
- Accurately documenting Electronic Medical Records to reflect approval or denial of treatment authorization.
- Communicating insurance authorizations/denials and insurance needs to appropriate internal staff.
- Scheduling and delivering concurrent authorization reviews as required by individual insurance companies.
- Coordinating physicians reviews and appeals.
Requirements
- Bachelor's Degree (preferred) or relevant experience
- Previous healthcare or insurance experience
- Knowledge of medical terminology and psychiatric criteria
- Ability to analyze and communicate clinical information from progress, group, and psychiatric chart notes
- Ability to work autonomously and independently while working collaboratively as part of a team
- Ability to think critically and make decisions within individual role and responsibility
- Strong written and verbal skills
- Strong organizational and time management skills with ability to manage workload independently
- Ability to foster and maintain positive relationships externally and internally
- Familiarity with Microsoft Office, Outlook, and EMR
Pay
The expected compensation range for this role is $45,000–$55,000 USD. This range includes multiple career path levels across the organization; where you fall in the range is dependent upon a number of factors including, but not limited to, your years of experience, type of experience, location, and education/certifications.
Benefits & Perks
For eligible positions, our benefits include:
- Comprehensive medical, dental, and vision plans
- 401k program with company matching
- Generous PTO (including competitive parental leave after 1 year of employment)
- Continuous training through CEU seminars and volunteering opportunities
- Opportunities for growth and continuous development within our organization
About Us
Compass Health Center is a recognized leader in crisis-level mental health, bringing passion, connection, and patient-centered care to the Partial Hospitalization and Intensive Outpatient space (PHP/IOP). Based in Chicagoland, we serve hundreds of patients every day, ranging from ages 5 through adulthood, in our onsite facilities or through our flourishing virtual programming. Compass fills a critical gap between outpatient and inpatient care through an intermediate level of Behavioral Healthcare.
Our values include cultural humility, teamwork, continuous improvement, connection, patient-centered care, passion, innovation, and agility.