UR Specialist

We are seeking a highly motivated and detail-oriented individual to join our growing team in a newly created hybrid role that spans utilization review (UR), medical billing, collections, accounting, and finance. This is an exciting opportunity to build something new from the ground up. The ideal candidate will be an adaptive problem-solver with a comprehensive understanding of the substance abuse industry, and a passion for working cross-functionally to improve financial outcomes and operational efficiency.

 

Utilization Review & Claims Readiness

• Collaborate with UR team to ensure authorizations are obtained, tracked, and aligned with level of care and documentation.
• Assist in reviewing census data, documentation, and ASAM criteria to support claim validity.
• Identify gaps or inconsistencies that may delay billing and escalate for resolution.

Billing & Revenue Cycle

• Submit claims through KIPU & CollaborateMD, ensuring proper coding and payer alignment.
• Monitor rejected and denied claims; prepare corrections or re-submissions with appropriate documentation.
• Maintain timely submission of census-driven billing across all levels of care.

Collections & AR Management

• Track claim status via payer portals; follow up with carriers to resolve unpaid or underpaid claims.
• Support appeals, documentation requests, and COB coordination.
• Review and reconcile insurance payments and remittance data; escalate discrepancies.

Financial Reporting & Analysis

• Reconcile billed vs. collected amounts by payor and level of care; identify underperformance trends.
• Work with finance to support cash forecasting, bad debt reserves, and monthly close.
• Prepare monthly KPI dashboards for AR aging, collection rates, and denials.

Cross-Functional Collaboration

• Act as a liaison between Billing, UR, Collections, Accounting, and Leadership teams.
• Assist with compliance audits, payer documentation, and operational improvements.
• Help implement new SOPs and billing workflows as the department scales.

• High school diploma or GED required. Associate's degree preferred
• Bachelor's degree in Healthcare Administration, Nursing, Social Work, Psychology, or a related field preferred.
• Experience in behavioral health settings and comfort working directly with patients or patient-facing teams is a strong plus.
• Familiarity with behavioral health/substance abuse treatment and medical billing strongly preferred.
• Comfortable working with patients or patient-facing teams to resolve insurance or billing issues.
• Intermediate to advanced Excel/Google Sheets skills.
• Strong communication, analytical, and organizational skills.

Benefits

• Health Insurance (Medical, Dental, Vision)
• Paid Time Off (PTO) – vacation, holidays- 3 WEEKS PTO
• Paid Holidays
• 401(k) Retirement Plan
• Life Insurance
• Disability Insurance – Short-term and/or Long-term
• Employee Assistance Program (EAP)