ABA Utilization Review Specialist
New
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Spectrum Billing SolutionsHealthcare revenue cycle
Source API remote eligibility restrictions: United StatesFull-TimeMiddle
Salary not disclosed
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Job Details
- Experience
- 3-5 years of Utilization Review experience.
- Required Skills
- Microsoft ExcelHIPAA
Requirements
- Have 3-5 years of Utilization Review experience.
- ABA and/or behavioral health experience is preferred.
- A bachelor’s or master’s degree is preferred.
- Demonstrate strong written and oral communication skills.
- Have attention to detail to capture and properly document necessary information.
- Work independently and within a team.
- Be able to multitask, prioritize, and meet expected deadlines.
- Have a solid understanding of insurance benefits and coverages.
- Have strong computer skills, including Word, Excel, and billing software.
Responsibilities
- Review patient admission and clinical information for medical necessity and compliance with utilization review guidelines.
- Obtain initial and continuing authorization for treatment services.
- Manage authorization denials, including referral for peer review.
- Document and record necessary information.
- Monitor and track new and ongoing authorization cases.
- Collaborate with clinical staff to obtain necessary information and complete timely reviews.
- Assist external clients in understanding payer requirements for authorizations.
- Participate in team meetings.
- Maintain patient confidentiality and adhere to HIPAA regulations.
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