[Remote] Utilization Review Specialist

Note: The job is a remote job and is open to candidates in USA. Compass Health Center is a recognized leader in crisis-level mental health, providing patient-centered care in the Behavioral Health space. The Utilization Review Specialist will obtain insurance authorization for patients, act as a liaison between the clinical team and insurance companies, and advocate for patients to overcome financial barriers to treatment.

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

Skills

• Previous healthcare or insurance experience
• Knowledge of medical terminology and psychiatric criteria
• Have the ability to analyze and communicate clinical information from progress, group and psychiatric chart notes
• Have the ability to work autonomously and independently while working collaboratively as part of a team
• Have the ability to think critically and make decisions within individual role and responsibility
• Possess strong written and verbal skills
• Have strong organizational and time management skills with ability to manage workload independently
• Have the ability to foster and maintain positive relationships externally and internally
• Bachelor's Degree (preferred) or relevant experience
• Familiarity with Microsoft Office, Outlook, and EMR

Benefits

• Comprehensive medical/dental/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

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