Utilization Review Specialist
Acme Billing Solutions
Franklin, Tennessee
utilization
utilization review
insurance
utilization
utilization review
ur
management
advocacy
medical
providers
health
team
compliance
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December 22, 2022
Acme Billing Solutions
Franklin, Tennessee
FULL_TIME
The Utilization Review Specialist is responsible for prospective, retrospective, and concurrent utilization review activities to reflect client and care advocacy. They are a member of the multidisciplinary team and monitors documentation in the medical record for accuracy and clinical compliance.
Essential Function/Job Duties
- Comfortable working with common billing and EMR/EHR software
- Familiar with both inpatient and outpatient levels of care
- Maximize authorizations from insurance providers for all levels of care
- Is knowledgable of common medical necessity criteria
- Conduct reviews in a timely manner for each patient
- Manage utilization review schedule with providers
- Report and resolve any issues that affect authorizations
- Experience in mental health, chemical dependency, or psychiatric nursing
- Experience with peer-to-peer reviews +
- Attends UR meetings to discuss activities/needs of UR department
- Interacts with third-party payers, managed care organizations, and gatekeeper organizations
- Works closely with clinical staff and provides feedback regarding findings that may benefit reviews
- Ability to speak clearly and persuasively in positive or negative situations
- Good interpersonal skills, organized, positive attitude, excellent verbal and written skills, excellent organizational skills, self-motivated and driven.
- Complies with all performance measuring regarding pre-certification, concurrent reviews, and appeals
Competencies
- Thoroughness/Critical thinking skills
- Time management
- Project Management
- Problem Solving/Analysis
- Communication Proficiency
- Advocacy
Preferred Experience:
- One year of experience as a UR specialist
Office Location Pending. Inquire for more information.
Job Type: Full-time
Pay: $50,000.00 - $65,000.00 per year
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Disability insurance
- Flexible schedule
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- Monday to Friday
Ability to commute/relocate:
- Franklin, TN 37067: Reliably commute or planning to relocate before starting work (Required)
Experience:
- Utilization management: 1 year (Preferred)
Work Location: One location
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