Utilization Review Coordinator (UR Coordinator)

POSITION PURPOSE:
The Utilization Review Coordinator (UR Coordinator) is responsible to perform the process of 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, as well as the flow, organization, and reporting of information.

RESPONSIBILITIES:

This position reports to our Director of Utilization Review and will contribute to our overall efforts through the following responsibilities:

• CLINICAL DATA REVIEW – Review clinical data, including medical records, patient charts and provider notes to understand patient history and to gain 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 to facilitate continued stay. Utilize knowledge of billing process and clinical data to present viable arguments for insurance coverage.


• APPEALS ADVOCACY – Speak with clinicians at insurance company upon denial of coverage to communicate relevant clinical information and bring light to individualized patient issues that necessitate coverage for prior treatment. Utilize facts to communicate in knowledgeable, persistent, passionate and or creative manner to achieve desired results for client base.
  

WORK SCHEDULE:

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

QUALIFICATIONS:

• 4 + years prior experience in a utilization review capacity or equivalent experience. Must demonstrate prior experience, knowledge of 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 or appeals specialist and/or other support staff in treatment facilities is highly desirable.


• Strong computer skills and knowledge of MS Office products, including skills in MS Excel required. Ability to quickly navigate between platforms necessary.


• Strong written and verbal communication skills are a must have.


• College degree preferred but not required.


• Medical and or clinical background/education is preferred but not required.